title: Temporal trends in treatment outcomes for HIV-1 and HIV-2-infected adults enrolled in Côte d'Ivoire's national antiretroviral therapy program.
abstract: BACKGROUND
  In Côte d'Ivoire during 2004-2007, numbers of ART enrollees increased from <5,000 to 36,943. Trends in nationally representative ART program outcomes have not yet been reported.
  
  
  RESULTS
  We conducted a retrospective chart review to assess trends in patient characteristics and attrition [death or loss to follow-up (LTFU)] over time, among a nationally representative sample of 3,682 adults (≥15 years) initiating ART during 2004-2007 at 34 health facilities. Among ART enrollees during 2004-2007, median age was 36, the proportion female was 67%, the proportion HIV-2-infected or dually HIV-1&2 reactive was 5%, and median baseline CD4+ T-cell (CD4) count was 135 cells/µL. Comparing cohorts initiating ART in 2004 with cohorts initiating ART in 2007, median baseline weight declined from 55 kg to 52 kg (p = 0.008) and the proportion weighing <45 kg increased from 17% to 22% (p = 0.014). During 2004-2007, pharmacy-based estimates of the percentage of new ART enrollees ≥95% adherent to ART declined from 74% to 60% (p = 0.026), and twelve-month retention declined from 86% to 69%, due to increases in 12-month mortality from 2%-4% and LTFU from 12%-28%. In univariate analysis, year of ART initiation was associated with increasing rates of both LTFU and mortality. Controlling for baseline CD4, weight, adherence, and other risk factors, year of ART initiation was still strongly associated with LTFU but not mortality. In multivariate analysis, weight <45 kg and adherence <95% remained strong predictors of LTFU and mortality.
  
  
  CONCLUSIONS
  During 2004-2007, increasing prevalence among ART enrollees of measured mortality risk factors, including weight <45 kg and ART adherence <95%, might explain increases in mortality over time. However, the association between later calendar year and increasing LTFU is not explained by risk factors evaluated in this analysis. Undocumented transfers, political instability, and patient dissatisfaction with crowded facilities might explain increasing LTFU.
authors.affiliation: Division of Global HIV/AIDS, Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America.
authors.forename: Andrew F
authors.initials: AF
authors.lastname: Auld
authors.affiliation: Division of Global HIV/AIDS, Centers for Disease Control and Prevention, Abidjan, Côte d'Ivoire.
authors.forename: Kunomboa A
authors.initials: KA
authors.lastname: Ekra
authors.affiliation: Division of Global HIV/AIDS, Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America.
authors.forename: Ray W
authors.initials: RW
authors.lastname: Shiraishi
authors.affiliation: National Program for Medical Care of Persons Living with HIV/AIDS, Ministry of Health, Abidjan, Côte d'Ivoire.
authors.forename: Moise Z
authors.initials: MZ
authors.lastname: Tuho
authors.affiliation: Elizabeth Glaser Pediatric AIDS Foundation, Abidjan, Côte d'Ivoire.
authors.forename: Joseph S
authors.initials: JS
authors.lastname: Kouakou
authors.affiliation: Elizabeth Glaser Pediatric AIDS Foundation, Abidjan, Côte d'Ivoire; Department of Economy and Finance, Directorate General of Budget and Finance, Abidjan, Côte d'Ivoire.
authors.forename: Fayama
authors.initials: F
authors.lastname: Mohamed
authors.affiliation: National Program for Medical Care of Persons Living with HIV/AIDS, Ministry of Health, Abidjan, Côte d'Ivoire.
authors.forename: Virginie
authors.initials: V
authors.lastname: Ettiègne-Traoré
authors.affiliation: Division of Global HIV/AIDS, Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America.
authors.forename: Jennifer
authors.initials: J
authors.lastname: Sabatier
authors.affiliation: Elizabeth Glaser Pediatric AIDS Foundation, Abidjan, Côte d'Ivoire.
authors.forename: Joseph
authors.initials: J
authors.lastname: Essombo
authors.affiliation: Elizabeth Glaser Pediatric AIDS Foundation, Los Angeles, California, United States of America.
authors.forename: Georgette
authors.initials: G
authors.lastname: Adjorlolo-Johnson
authors.affiliation: Elizabeth Glaser Pediatric AIDS Foundation, Los Angeles, California, United States of America.
authors.forename: Richard
authors.initials: R
authors.lastname: Marlink
authors.affiliation: Division of Global HIV/AIDS, Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America.
authors.forename: Tedd V
authors.initials: TV
authors.lastname: Ellerbrock
mesh_terms: D000328:Adult; D019380:Anti-HIV Agents / Q000627:therapeutic use*; D005260:Female; D005500:Follow-Up Studies; D015658:HIV Infections / Q000188:drug therapy* / Q000401:mortality* / Q000821:virology; D015497:HIV-1; D015498:HIV-2; D006801:Humans; D008297:Male; D009026:Mortality / Q000639:trends*; D015397:Program Evaluation; D012189:Retrospective Studies; D012307:Risk Factors; D015996:Survival Rate; D016896:Treatment Outcome
chemical_list: D019380:Anti-HIV Agents