Eight years experience with attrition and mortality on antiretroviral therapy in South Africa

Abstract

Design: We conducted a retrospective cohort analysis of HIV-infected adults (≥18) who initiated standard first-line antiretroviral therapy (ART) at 7 public-sector HIV clinics in Gauteng and Mpumalanga Provinces in South Africa between April 2004 and May 2012. Only patients with a national ID number to allow for linkage with the national death registry were included. Analysis: We used Kaplan-Meier analysis to estimate attrition (death or loss to folluw-up [LTF]) over eight years. Incidence rates of death, loss to follow-up (LTF), and attrition per 1000 person-years are presented for patients who initiated between April 2004 and March 2005. Results: – Among 1764 patients initiated from April 2004-March 2005: After 8 years on ART 19.6% (95% CI: 17.7% – 21.5%) died and 15.6% (95% CI: 13.9% – 17.4%) were lost; Total attrition by 8 years was 35.1% (95 % CI: 32.9% – 37.4%) – In total cohort of 35,219 patients using Kaplan Meier analysis: 9.0%, 12.0%, 18.8% and 24.8% of patients had died by 1, 2, 5 and 8 years on ART respectively; 78.0%, 64.3%, 38.1% and 24.7% of patients were alive and on treatment by 1, 2, 5 and 8 years on ART. Conclusions: A large dataset of patients enrolled in public-sector ART programs at various sites in South Africa showed good retention by 8 years on treatment.

Conference: IWHOD 2014, Sitges, Spain