title: Mortality and loss to follow-up in the first year of ART:  Malawi national ART programme.
abstract: OBJECTIVE
  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.
  
  
  METHODS
  Cohort study including all patients who started ART in Malawi's public sector clinics between 2004 and 2007.
  
  
  METHODS
  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 (sHRs) of outcomes adjusted for patient and clinic-level characteristics were calculated in multivariable analysis, applying competing risk models.
  
  
  RESULTS
  A total of 117,945 patients contributed 85,246 person-years: 1.0% were infants below 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% confidence interval (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.
  
  
  CONCLUSIONS
  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 men were at higher risk than women. Interventions to improve outcomes in these patient groups are required.
authors.affiliation: Liverpool School of Tropical Medicine, UK.
authors.forename: Ralf
authors.initials: R
authors.lastname: Weigel
authors.forename: Janne
authors.initials: J
authors.lastname: Estill
authors.forename: Matthias
authors.initials: M
authors.lastname: Egger
authors.forename: Anthony D
authors.initials: AD
authors.lastname: Harries
authors.forename: Simon
authors.initials: S
authors.lastname: Makombe
authors.forename: Hannock
authors.initials: H
authors.lastname: Tweya
authors.forename: Andreas
authors.initials: A
authors.lastname: Jahn
authors.forename: Olivia
authors.initials: O
authors.lastname: Keiser
mesh_terms: D000293:Adolescent; D000328:Adult; D019380:Anti-HIV Agents / Q000627:therapeutic use*; D018791:CD4 Lymphocyte Count; D002648:Child; D002675:Child, Preschool; D015331:Cohort Studies; D005260:Female; D005500:Follow-Up Studies; D015658:HIV Infections / Q000188:drug therapy / Q000191:economics / Q000401:mortality*; D006297:Health Services Accessibility / Q000191:economics / Q000706:statistics & numerical data*; D006801:Humans; D015994:Incidence; D007223:Infant; D007231:Infant, Newborn; D059012:Lost to Follow-Up; D008295:Malawi / Q000453:epidemiology; D008297:Male; D008875:Middle Aged; D010342:Patient Acceptance of Health Care / Q000706:statistics & numerical data*; D012307:Risk Factors; D017678:Sex Distribution; D055815:Young Adult
chemical_list: D019380:Anti-HIV Agents
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