title: Socioeconomic determinants of mortality in HIV: evidence from a clinical cohort in Uganda.
abstract: OBJECTIVE
  To delineate the association between baseline socioeconomic status (SES) indicators and mortality and lost to follow-up (LTFU) in a cohort of HIV-infected individuals enrolled in antiretroviral therapy (ART) in urban Uganda.
  
  
  METHODS
  Retrospective cohort study nested in an antiretroviral clinic-based cohort.
  
  
  METHODS
  SES indicators including education, employment status, and a standardized wealth index, and other demographic and clinical variables were assessed at baseline among ART-treated patients in a clinic-based cohort in Kampala, Uganda. Confirmed mortality (primary outcome) and LTFU (secondary outcome) were actively ascertained over a 4-year follow-up period from 2005 to 2009.
  
  
  RESULTS
  Among 1763 adults [70.5% female; mean age, 36.2 years (SD = 8.4)] enrolled in ART, 14.4% (n = 253) were confirmed dead and 19.7% (n = 346) were LTFU at 4-year follow-up. No formal education [adjusted odds ratio (AOR) 1.76; 95% confidence interval (CI): 1.19 to 2.59], having fewer than 6 dependents (AOR 1.39; 95% CI: 1.04 to 1.86), unemployment (AOR 1.98; 95% CI: 1.48 to 2.66), and housing tenure index score (a component of the wealth index) (AOR 1.11; 95% CI: 1.00 to 1.23) were significantly associated with confirmed mortality at 4 years. SES indicators were not associated with LTFU at 4 years.
  
  
  CONCLUSIONS
  Baseline SES indicators, including education, number of dependents, employment status, and components of a standard wealth index may indicate long-term vulnerability to mortality in patients with HIV/AIDS, despite uniform access to ART. Future studies delineating the pathways through which poverty and limited assets affect clinical outcomes may lead to more effective HIV interventions in low-resource settings.
authors.affiliation: *Division of Child and Adolescent Psychiatry, Department of Psychiatry and Behavioral Sciences, Johns Hopkins Hospital, Johns Hopkins School of Medicine, Baltimore, MD; †Division of HIV/AIDS and Center for AIDS Prevention Studies, University of California, San Francisco, CA; ‡The Dartmouth Institute for Health Policy and Clinical Practice, Lebanon, NH; §Reach Out-Mbuya, Kampala, Uganda; ‖Division of Intramural Research, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, MD; ¶Division of Infectious Diseases, Johns Hopkins School of Medicine, Baltimore, MD; and #Johns Hopkins Bloomberg School of Public Health, Baltimore, MD.
authors.forename: Matthew D
authors.initials: MD
authors.lastname: Burkey
authors.forename: Sheri D
authors.initials: SD
authors.lastname: Weiser
authors.forename: Desiree
authors.initials: D
authors.lastname: Fehmie
authors.forename: Stella
authors.initials: S
authors.lastname: Alamo-Talisuna
authors.forename: Pamella
authors.initials: P
authors.lastname: Sunday
authors.forename: Joy
authors.initials: J
authors.lastname: Nannyunja
authors.forename: Steven J
authors.initials: SJ
authors.lastname: Reynolds
authors.forename: Larry W
authors.initials: LW
authors.lastname: Chang
mesh_terms: D000293:Adolescent; D000328:Adult; D015331:Cohort Studies; D005260:Female; D015658:HIV Infections / Q000453:epidemiology / Q000401:mortality*; D006801:Humans; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D012959:Socioeconomic Factors; D016019:Survival Analysis; D014454:Uganda / Q000453:epidemiology; D055815:Young Adult