title: Outcomes of antiretroviral treatment programs in rural Southern Africa.
abstract: BACKGROUND
  Data on outcomes of antiretroviral treatment (ART) programs in rural sub-Saharan African are scarce. We describe early losses and long-term outcomes in 6 rural programs in Southern Africa with limited access to viral load monitoring and second-line ART.
  
  
  METHODS
  Patients aged ≥16 years starting ART in 2 programs each in Zimbabwe, Mozambique, and Lesotho were included. We evaluated risk factors for no follow-up after starting ART and mortality and loss to follow-up (LTFU) over 3 years of ART, using logistic regression and competing risk models. Odds ratios and subdistribution hazard ratios, adjusted for gender, age category, CD4 category, and World Health Organization stage at start of ART are reported.
  
  
  RESULTS
  Among 7725 patients, 449 (5.8%) did not return after initiation of ART. During 9575 person-years, 698 (9.6%) of those with at least 1 follow-up visit died, and 1319 (18.1%) were LTFU. At 3 years, the cumulative incidence of death and LTFU were 12.5% (11.5%-13.5%) and 25.4% (24.0%-26.9%), respectively, with important differences between countries as follows: in Zimbabwe 75.1% (72.8%-77.3%) were alive and on ART at 3 years compared with 55.4% (52.8%-58.0%) in Lesotho and 51.6% (48.0%-55.2%) in Mozambique. In all settings, young age and male gender predicted LTFU, whereas advanced clinical stage and low baseline CD4 counts predicted death.
  
  
  CONCLUSIONS
  In African ART programs with limited access to second-line treatment, mortality, and LTFU are high in the first 3 years of ART. Low retention in care is a major threat to the sustainability of ART delivery in Southern Africa, particularly in rural sites.
authors: Division of International and Environmental Health, Institute of Social and Preventive Medicine, University of Bern, Bern, Switzerland. gwandeler@ispm.unibe.ch
authors: Gilles
authors: G
authors: Wandeler
authors: Olivia
authors: O
authors: Keiser
authors: Karolin
authors: K
authors: Pfeiffer
authors: Sabrina
authors: S
authors: Pestilli
authors: Christiane
authors: C
authors: Fritz
authors: Niklaus D
authors: ND
authors: Labhardt
authors: Franzisco
authors: F
authors: Mbofana
authors: Robert
authors: R
authors: Mudyiradima
authors: Jan
authors: J
authors: Emmel
authors: Matthias
authors: M
authors: Egger
authors: Jochen
authors: J
authors: Ehmer
mesh_terms: D000293:Adolescent; D000328:Adult; D017954:Africa South of the Sahara / Q000453:epidemiology; D019380:Anti-HIV Agents / Q000627:therapeutic use*; D015496:CD4-Positive T-Lymphocytes / Q000166:cytology; D003140:Communicable Disease Control / Q000295:instrumentation* / Q000379:methods; D005260:Female; D015658:HIV Infections / Q000188:drug therapy* / Q000401:mortality; D006297:Health Services Accessibility / Q000592:standards; D006801:Humans; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D017063:Outcome Assessment, Health Care; D010349:Patient Compliance / Q000706:statistics & numerical data; D010352:Patient Dropouts / Q000706:statistics & numerical data; D012307:Risk Factors; D019035:Rural Health Services / Q000458:organization & administration; D012424:Rural Population; D055815:Young Adult
chemical_list: D019380:Anti-HIV Agents