title: Gender differences in retention and survival on antiretroviral therapy of HIV-1 infected adults in Malawi.
abstract: BACKGROUND; There is currently a dearth of knowledge on gender differences in mortality among patients on ART in Africa.
  
  
  METHODS
  Using data from the national ART monitoring and evaluation system, a survival analysis of all healthcare workers, teachers, and police/army personnel who accessed ART in Malawi by June, September and December 2006 respectively, was undertaken. Gender differences in survival were analysed using Kaplan-Meier estimates and rate ratios were derived from Poisson regression adjusting for confounding.
  
  
  RESULTS
  4670 ART patients (49.8% female) were followed up for a median of 8.7 months after starting ART. Probability of death was significantly higher for men than women (p < 0.001). Controlling for age, WHO clinical stage and occupation, men experienced nearly 2 times the mortality of women RR 1.90 [95% CI: 1.57-2.29]. A higher proportion of men initiated ART in WHO stage 4 (p < 0.001).
  
  
  CONCLUSIONS
  Among healthcare workers, teachers, police/army personnel, men have higher mortality on ART than women. Possible reasons are unclear but could be biological or because men present for ART at a later clinical stage or have poorer adherence to therapy. Improving early access to ART may reduce mortality, especially among men. A gender difference in adherence to therapy needs further investigation.
authors: Medecins sans Frontieres, Medical Department (Operational Research), Brussels Operational Center, Brussels, Belgium.
authors: Katie
authors: K
authors: Taylor-Smith
authors: Hannock
authors: H
authors: Tweya
authors: Anthony
authors: A
authors: Harries
authors: Erik
authors: E
authors: Schoutene
authors: Andreas
authors: A
authors: Jahn
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