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Publication Details
AFRICAN RESEARCH NEXUS
SHINING A SPOTLIGHT ON AFRICAN RESEARCH
Characteristics and outcomes among older HIV-positive adults enrolled in HIV programs in four sub-Saharan African countries
PLoS ONE, Volume 9, No. 7, Article e103864, Year 2014
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Description
Background: Limited information exists on adults ≥50 years receiving HIV care in sub-Saharan Africa. Methodology: Using routinely-collected longitudinal patient-level data among 391,111 adults ≥15 years enrolling in HIV care from January 2005-December 2010 and 184,689 initiating ART, we compared characteristics and outcomes between older (≥50 years) and younger adults at 199 clinics in Kenya, Mozambique, Rwanda, and Tanzania. We calculated proportions over time of newly enrolled and active adults receiving HIV care and initiating ART who were ≥50 years; cumulative incidence of loss to follow-up (LTF) and recorded death one year after enrollment and ART initiation, and CD4+ response following ART initiation. Findings: From 2005-2010, the percentage of adults ≥50 years newly enrolled in HIV care remained stable at 10%, while the percentage of adults ≥50 years newly initiating ART (10% [2005]-12% [2010]), active in follow-up (10% [2005]-14% (2010]), and active on ART (10% [2005]-16% [2010]) significantly increased. One year after enrollment, older patients had significantly lower incidence of LTF (33.1% vs. 32.6%[40-49 years], 40.5%[25-39 years], and 56.3%[15-24 years]; p-value< 0.0001), but significantly higher incidence of recorded death (6.0% vs. 5.0% [40-49 years], 4.1% [25-39 years], and 2.8% [15-24 years]; p-valve<0.0001). LTF was lower after vs. before ART initiation for all ages, with older adults experiencing less LTF than younger adults. Among 85,763 ART patients with baseline and follow-up CD4+ counts, adjusted average 12-month CD4+ response for older adults was 20.6 cells/mm 3 lower than for adults 25-39 years of age (95% CI: 17.1-24.1). Conclusions: The proportion of patients who are ≥50 years has increased over time and been driven by aging of the existing patient population. Older patients experienced less LTF, higher recorded mortality and less robust CD4+ response after ART initiation. Increased programmatic attention on older adults receiving HIV care in sub-Saharan Africa is warranted. © 2014 Eduardo et al.
Available Materials
https://efashare.b-cdn.net/share/pmc/articles/PMC4116238/bin/pone.0103864.s001.docx
Authors & Co-Authors
Eduardo, Eduard
United States, New York
Mailman School of Public Health
Lamb, Matthew R.
United States, New York
Mailman School of Public Health
Kandula, Sasi
United States, New York
Mailman School of Public Health
Howard, Andrea A.
United States, New York
Mailman School of Public Health
Mugisha, Veronicah
United States, New York
Mailman School of Public Health
Kimanga, Davies O.
Kenya, Nairobi
Ministry of Health Nairobi
Kilama, Bonita K.
Tanzania, Dar es Salaam
Ministry of Health and Social Welfare
El-Sadr, W. M.
United States, New York
Mailman School of Public Health
Elul, Batya
United States, New York
Mailman School of Public Health
Statistics
Citations: 39
Authors: 9
Affiliations: 3
Identifiers
Doi:
10.1371/journal.pone.0103864
e-ISSN:
19326203
Research Areas
Health System And Policy
Infectious Diseases
Study Design
Cross Sectional Study
Cohort Study
Study Locations
Kenya
Mozambique
Rwanda
Tanzania