Outcomes of the Botswana national HIV/AIDS treatment programme from 2002 to 2010: a longitudinal analysis
Outcomes of the Botswana national HIV/AIDS treatment programme from 2002 to 2010: a longitudinal analysis
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DOI：
10.1016/s2214-109x(13)70149-9
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发表时间：
2014-01-01
影响因子：
34.3
通讯作者：
Marlink, Richard
中科院分区：
文献类型：
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作者：
Farahani, Mansour;Vable, Anusha;Marlink, Richard
在撒哈拉以南非洲接受抗逆转录病毒治疗（ART）的艾滋病毒感染者的短期死亡率高于高收入国家，但由于缺乏可用数据，尚未进行系统的长期比较。我们分析了2002年至2010年博茨瓦纳国家ART计划（Masa）实施的效果。方法Masa计划于2002年1月21日开始实施。通过博茨瓦纳卫生部开发的临床信息系统，前瞻性地收集了根据国家指南符合抗逆转录病毒疗法条件的患者的数据。提取2010年4月30日之前入组的成人（≥ 18岁）的所有可用电子记录的数据集并发送给研究团队。所有数据在分析前均匿名。主要结局为死亡率。为了评估损失的后续行动的影响，我们做了一系列的敏感性分析，假设不同比例的人口失去后续dead.Findings我们分析了126263例患者的记录，其中102713记录开始的ART。中位随访时间为35个月（IQR 14-56），中位数为8个随访访视（4-14）。到研究结束时，15270例患者被视为失访。63%（78 866）的研究人群为女性;基线时女性的中位年龄为34岁（IQR 29-41），男性为38岁（33-45）。在9年的研究期间，记录了10230例（8%）死亡。治疗开始后的前3个月死亡率最高，为12.8例死亡/100人-年（95% CI 12.4-13.2），但下降至1.16例死亡/100人-年（1.12-1.2），在接下来的7年随访中，每100人年死亡0.15例（0.09-0.25）。在2002年Masa计划开始后的每个日历年，入学时的平均CD 4细胞计数增加（从2002年的101个细胞/μ L [IQR 44-156]增加到2010年的191个细胞/μ L [115-239]）。每年，当年死亡的总登记人口比例从2002年的63%（140人中的88人）下降到2010年的0.8%（1599人中的13人）。一项敏感性分析假设60%的失访人群已经死亡，结果增加了3000例死亡，总体死亡率从8%增加到11- 13%。解释博茨瓦纳国家艾滋病毒/艾滋病治疗计划将艾滋病毒感染者的死亡率降低到与其他低收入或中等收入国家大致相同的水平。
Background Short-term mortality rates among patients with HIV receiving antiretroviral therapy (ART) in sub-Saharan Africa are higher than those recorded in high-income countries, but systematic long-term comparisons have not been made because of the scarcity of available data. We analysed the effect of the implementation of Botswana's national ART programme, known as Masa, from 2002 to 2010.Methods The Masa programme started on Jan 21, 2002. Patients who were eligible for ART according to national guidelines had their data collected prospectively through a clinical information system developed by the Botswana Ministry of Health. A dataset of all available electronic records for adults (>= 18 years) who had enrolled by April 30, 2010, was extracted and sent to the study team. All data were anonymised before analysis. The primary outcome was mortality. To assess the effect of loss to follow-up, we did a series of sensitivity analyses assuming varying proportions of the population lost to follow-up to be dead.Findings We analysed the records of 126 263 patients, of whom 102 713 had documented initiation of ART. Median follow-up time was 35 months (IQR 14-56), with a median of eight follow-up visits (4-14). 15 270 patients were deemed lost to follow-up by the end of the study. 63% (78 866) of the study population were women; median age at baseline was 34 years for women (IQR 29-41) and 38 years for men (33-45). 10 230 (8%) deaths were documented during the 9 years of the study. Mortality was highest during the first 3 months after treatment initiation at 12.8 deaths per 100 person-years (95% CI 12.4-13.2), but decreased to 1.16 deaths per 100 person-years (1.12-1.2) in the second year of treatment, and to 0.15 deaths per 100 person-years (0.09-0.25) over the next 7 years of follow-up. In each calendar year after the start of the Masa programme in 2002, average CD4 cell counts at enrolment increased (from 101 cells/mu L [IQR 44-156] in 2002, to 191 cells/mu L [115-239] in 2010). In each year, the proportion of the total enrolled population who died in that year decreased, from 63% (88 of 140) in 2002, to 0.8% (13 of 1599) in 2010. A sensitivity analysis assuming that 60% of the population lost to follow-up had died gave 3000 additional deaths, increasing overall mortality from 8% to 11-13%.Interpretation The Botswana national HIV/AIDS treatment programme reduced mortality among adults with HIV to levels much the same as in other low-income or middle-income countries.