The impact of gender and income on survival and retention in a South African antiretroviral therapy programme.
The impact of gender and income on survival and retention in a South African antiretroviral therapy programme.
复制标题
性别和收入对南非抗逆转录病毒疗法计划中生存和保留的影响。
DOI：
10.1111/j.1365-3156.2009.02290.x
复制
发表时间：
2009-07
期刊：
影响因子：
--
通讯作者：
Wood R
中科院分区：
文献类型：
--
作者：
Cornell M;Myer L;Kaplan R;Bekker LG;Wood R
目标 尽管非洲的抗逆转录病毒治疗 (ART) 服务迅速扩展，但关于女性和男性的结果是否存在差异以及哪些因素可能导致这种差异的数据很少。我们在南非 ART 项目中调查了性别和收入与生存率和保留率之间的关系。方法对总共 2196 名未接受过治疗的成年人进行为期 1 年的 ART 随访。使用比例风险回归来探讨基线特征与生存率和失访率 (LTFU) 之间的关联。结果患者主要为女性 (67%)。男性发病年龄较大，艾滋病毒疾病更严重，并且在早期 ART 期间，男性的粗死亡率高于女性（22.8vs12.5/100 人年；P= 0.002）。然而，在多变量分析中，调整基线临床和免疫病毒学状态后，性别与生存率没有显着相关（HR = 1.46，95% CI = 0.96–2.22；P= 0.076）。在ART晚期（4-12个月），死亡率没有性别差异（3.5vs3.8/100人年；P= 0.817）。在多变量分析中，生存率与年龄密切相关（HR = 1.05，95% CI = 1.02–1.09；P< 0.001），CD4计数>150vs<50个细胞/μl（HR = 0.35，95% CI = 0.14–0.87；P= 0.023）和任何月收入与无（HR = 0.47，95% CI = 0.25–0.88；P= 0.018）。在接受 ART 治疗 1 年时，拥有一定的月收入可以预防 LTFU（调整后的 HR = 0.56，95% CI = 0.39–0.82；P= 0.002）。 结论 男性接受 ART 后的高早期死亡率主要是由于他们患有更晚期的 HIV 疾病。需要努力让男性在艾滋病毒疾病早期接受护理，并减少抗逆转录病毒治疗项目结果中的社会经济不平等。
ObjectivesDespite 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.MethodsA 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).ResultsPatients 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 (22.8vs12.5/100 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 (3.5vs3.8/100 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 >150vs<50 cells/μl (HR = 0.35, 95% CI = 0.14–0.87;P= 0.023) and any monthly incomevsnone (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).ConclusionMen’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.
登录
查看更多内容
DOI：
10.1089/154099903765448907
发表时间：
2003-05-01
期刊：
JOURNAL OF WOMENS HEALTH & GENDER-BASED MEDICINE
影响因子：
--
作者：
Box, TL;Olsen, M;Keitz, SA
通讯作者：
Keitz, SA
影响因子：
168.9
作者：
Braitstein, P;Brinkhof, MWG;Egger, M
通讯作者：
Egger, M
影响因子：
4.5
作者：
Muula AS;Ngulube TJ;Siziya S;Makupe CM;Umar E;Prozesky HW;Wiysonge CS;Mataya RH
通讯作者：
Mataya RH
影响因子：
3.8
作者：
Nicastri, E;Angeletti, C;Vella, S
通讯作者：
Vella, S
影响因子：
3.5
作者：
Braitstein, Paula;Boulle, Andrew;Low, Nicola
通讯作者：
Low, Nicola