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Publication Details
AFRICAN RESEARCH NEXUS
SHINING A SPOTLIGHT ON AFRICAN RESEARCH
immunology and microbiology
The impact of gender and income on survival and retention in a south african antiretroviral therapy programme
Tropical Medicine and International Health, Volume 14, No. 7, Year 2009
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Description
Objectives Despite the rapid expansion of antiretroviral therapy (ART) services in Africa, there are few data on whether outcomes differ for women and men and what factors may drive such variation. We investigated the association of gender and income with survival and retention in a South African ART programme. Methods A total of 2196 treatment-naïve adults were followed for 1 year on ART. Proportional hazards regression was used to explore associations between baseline characteristics and survival and loss-to-follow-up (LTFU). Results Patients were predominantly female (67%). Men presented at an older age and with more advanced HIV disease, and during early ART the crude death rate was higher among men than women (22.8 vs 12.5/100 person-years; P = 0.002). However in multivariate analysis, gender was not significantly associated with survival after adjusting for baseline clinical and immunovirological status (HR = 1.46, 95% CI = 0.96-2.22; P = 0.076). In late ART (4-12 months), there was no gender difference in mortality rates (3.5 vs 3.8/100 person-years; P = 0.817). In multivariate analysis, survival was strongly associated with age (HR = 1.05, 95% CI = 1.02-1.09; P < 0.001), CD4 count >150 vs <50 cells/μl (HR = 0.35, 95% CI = 0.14-0.87; P = 0.023) and any monthly income vs none (HR = 0.47, 95% CI = 0.25-0.88; P = 0.018). Having some monthly income was protective against LTFU at 1 year on ART (adjusted HR = 0.56, 95% CI = 0.39-0.82; P = 0.002). Conclusion Men's high early mortality on ART appears due largely to their presentation with more advanced HIV disease. Efforts are needed to enrol men into care earlier in HIV disease and to reduce socio-economic inequalities in ART programme outcomes. © 2009 Blackwell Publishing Ltd.
Authors & Co-Authors
Cornell, M.
South Africa, Cape Town
University of Cape Town
South Africa, Johannesburg
University of the Witwatersrand
Myer, Landon
South Africa, Cape Town
University of Cape Town
United States, New York
Mailman School of Public Health
Kaplan, Richard
South Africa, Cape Town
University of Cape Town
Bekker, Linda-Gail Gail
South Africa, Cape Town
University of Cape Town
Wood, Robin Y.
South Africa, Cape Town
University of Cape Town
Statistics
Citations: 132
Authors: 5
Affiliations: 3
Identifiers
Doi:
10.1111/j.1365-3156.2009.02290.x
ISSN:
13602276
e-ISSN:
13653156
Research Areas
Infectious Diseases
Study Design
Cohort Study
Participants Gender
Male
Female