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Publication Details
AFRICAN RESEARCH NEXUS
SHINING A SPOTLIGHT ON AFRICAN RESEARCH
Early mortality among adults accessing a community-based antiretroviral service in South Africa: Implications for programme design
AIDS, Volume 19, No. 18, Year 2005
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Description
Objectives: To determine rates, risk factors and causes of death among patients accessing a community-based antiretroviral treatment (ART) programme both prior to and following initiation of treatment. Methods: All in-programme deaths were ascertained between September 2002 and March 2005 among treatment-naive patients enrolled into a prospective community-based ART cohort in Cape Town, South Africa. Results: Of 712 patients (median CD4 cell count, 94 cells/μl), 578 (81%) started triple ART a median of 29 days after enrolment. 68 (9.5%) patients died during 563 person-years of observation. The high pretreatment mortality rate of 35.6 deaths/100 person-years [95% confidence interval (CI), 23.0-55.1) decreased to 2.5/100 person-years (95% CI, 0.9-6.6) at 1 year among those who received ART. However, within the first 90 days from enrolment, 29 of 44 (66%) deaths occurred among patients awaiting ART; these would not be identified by an on-treatment analysis. Multivariate analysis showed that risk of death (both pre-treatment and on-treatment) was independently associated with baseline CD4 cell count and World Health Organization (WHO) clinical stage; stage 4 disease was the strongest risk factor. Major attributed causes of death were wasting syndrome, tuberculosis, acute bacterial infections, malignancy and immune reconstitution disease. Conclusions: Most early in-programme deaths occurred among patients with advanced immunodeficiency but who had not yet started ART. Programme evaluation using on-treatment analyses greatly underestimated early mortality. This mortality would be reduced by minimizing unnecessary in-programme delays in treatment initiation and by starting ART before development of WHO stage 4 disease. © 2005 Lippincott Williams & Wilkins.
Authors & Co-Authors
Lawn, Stephen D.
Unknown Affiliation
Myer, Landon
Unknown Affiliation
Orrell, Catherine J.
Unknown Affiliation
Bekker, Linda-Gail Gail
Unknown Affiliation
Wood, Robin Y.
Unknown Affiliation
Statistics
Citations: 401
Authors: 5
Affiliations: 5
Identifiers
Doi:
10.1097/01.aids.0000194802.89540.e1
Study Design
Cohort Study
Study Locations
South Africa