Mortality and loss to follow-up in the first year of ART: Malawi national ART programme.
Mortality and loss to follow-up in the first year of ART: Malawi national ART programme.
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DOI：
10.1097/qad.0b013e32834ed814
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发表时间：
2012-01-28
期刊：
影响因子：
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通讯作者：
Keiser O
中科院分区：
文献类型：
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作者：
Weigel R;Estill J;Egger M;Harries AD;Makombe S;Tweya H;Jahn A;Keiser O
分析马拉维国家抗逆转录病毒治疗方案中所有年龄组在抗逆转录病毒治疗第一年的死亡率、失访率（LTFU）和继续接受抗逆转录病毒治疗的情况。队列研究包括2004年至2007年期间在马拉维公共部门诊所开始抗逆转录病毒疗法的所有患者。对抗逆转录病毒治疗登记册进行拍照，将信息输入数据库，并与电子记录诊所的数据合并。计算每100患者年的尿潴留发生率和累积发生率。应用竞争风险模型，在多变量分析中计算根据患者和临床水平特征调整的结局的亚危险比（sHR）。共117，945例患者，占85，246人-年：1.0%为2岁以下婴儿，7.4%为2-14岁儿童，7.5%为15-24岁年轻人，84.2%为25岁及以上成人。60%的患者是女性：14至35岁的女性人数超过男性。20岁以上男性的死亡率和LTFU较高。婴儿和年轻人每100人年的死亡率最高（23.0和19.4）和LTFU（24.7和19.3），以及与25-34岁年龄组相比的最高调整相对风险：死亡的sHR分别为1.37（95%CI 1.17-1.60）和1.17（95%CI 1.10-1.25），LTFU分别为1.37（95%CI 1.18-1.59）和1.27（95%CI 1.19-1.35）。在这项全国范围的研究中，0-1岁和15-24岁的患者死亡和LTFU的风险最高，20岁及以上的男性风险高于女性。需要采取干预措施来改善这些患者群体的结局。
To analyse mortality, loss to follow-up (LTFU) and retention on antiretroviral treatment (ART) in the first year of ART across all age-groups in the Malawi national ART programme. Cohort study including all patients who started ART in Malawi’s public sector clinics between 2004 and 2007. ART registers were photographed, information entered into a database and merged with data from clinics with electronic records. Rates per 100 patient-years and cumulative incidence of retention were calculated. Subhazard ratios (sHR) of outcomes adjusted for patient and clinic level characteristics were calculated in multivariate analysis, applying competing risk models. A total of 117,945 patients contributed 85,246 person-years: 1.0% were infants <2 years, 7.4 % children 2–14, 7.5% young people 15–24, and 84.2% adults 25 years and above. Sixty percent of patients were female: women outnumbered men from age 14 to 35 years. Mortality and LTFU were higher in men from age 20 years. Infants and young people had the highest rates per 100 person-years for mortality (23.0 and 19.4) and LTFU (24.7 and 19.3), and the highest adjusted relative risks compared to age group 25–34 years: sHRs were 1.37 (95%CI 1.17–1.60) and 1.17 (95%CI 1.10–1.25) for death and 1.37 (95%CI 1.18–1.59) and 1.27 (95%CI 1.19–1.35) for LTFU, respectively. In this country-wide study patients aged 0–1 and 15–24 years had the highest risk of death and LTFU, and from age 20 and older men were at higher risk than women. Interventions to improve outcomes in these patient groups are required.