Survival of HIV-Infected Adolescents on Antiretroviral Therapy in Uganda: Findings from a Nationally Representative Cohort in Uganda
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Date
2011
Journal Title
Journal ISSN
Volume Title
Publisher
PLoS ONE
Abstract
Adolescents have been identified as a high-risk group for poor adherence to and defaulting from combination
antiretroviral therapy (cART) care. However, data on outcomes for adolescents on cART in resource-limited settings remain
scarce.
Methods: We developed an observational study of patients who started cART at The AIDS Service Organization (TASO) in
Uganda between 2004 and 2009. Age was stratified into three groups: children (#10 years), adolescents (11–19 years), and
adults ($20 years). Kaplan-Meier survival curves were generated to describe time to mortality and loss to follow-up, and Cox
regression used to model associations between age and mortality and loss to follow-up. To address loss to follow up, we
applied a weighted analysis that assumes 50% of lost patients had died.
Findings: A total of 23,367 patients were included in this analysis, including 810 (3.5%) children, 575 (2.5%) adolescents, and
21 982 (94.0%) adults. A lower percentage of children (5.4%) died during their cART treatment compared to adolescents
(8.5%) and adults (10%). After adjusting for confounding, other features predicted mortality than age alone. Mortality was
higher among males (p,0.001), patients with a low initial CD4 cell count (p,0.001), patients with advanced WHO clinical
disease stage (p,0.001), and shorter duration of time receiving cART (p,0.001). The crude mortality rate was lower for
children (22.8 per 1000 person-years; 95% CI: 16.1, 29.5), than adolescents (36.5 per 1000 person-years; 95% CI: 26.3, 46.8)
and adults (37.5 per 1000 person-years; 95% CI: 35.9, 39.1).
Description
Keywords
HIV-Infected Adolescents, Antiretroviral Therapy, Uganda, Nationally Representative Cohort
Citation
Bakanda C, Birungi J, Mwesigwa R, Nachega JB, Chan K, et al. (2011) Survival of HIV-Infected Adolescents on Antiretroviral Therapy in Uganda: Findings from a Nationally Representative Cohort in Uganda. PLoS ONE 6(4): e19261. doi:10.1371/journal.pone.0019261