title: Characteristics and outcomes among older HIV-positive adults enrolled in HIV programs in four sub-Saharan African countries.
abstract: BACKGROUND
  Limited information exists on adults ≥50 years receiving HIV care in sub-Saharan Africa.
  
  
  METHODS
  Using routinely-collected longitudinal patient-level data among 391,111 adults ≥15 years enrolling in HIV care from January 2005-December 2010 and 184,689 initiating ART, we compared characteristics and outcomes between older (≥50 years) and younger adults at 199 clinics in Kenya, Mozambique, Rwanda, and Tanzania. We calculated proportions over time of newly enrolled and active adults receiving HIV care and initiating ART who were ≥50 years; cumulative incidence of loss to follow-up (LTF) and recorded death one year after enrollment and ART initiation, and CD4+ response following ART initiation.
  
  
  RESULTS
  From 2005-2010, the percentage of adults ≥50 years newly enrolled in HIV care remained stable at 10%, while the percentage of adults ≥50 years newly initiating ART (10% [2005]-12% [2010]), active in follow-up (10% [2005]-14% (2010]), and active on ART (10% [2005]-16% [2010]) significantly increased. One year after enrollment, older patients had significantly lower incidence of LTF (33.1% vs. 32.6%[40-49 years], 40.5%[25-39 years], and 56.3%[15-24 years]; p-value<0.0001), but significantly higher incidence of recorded death (6.0% vs. 5.0% [40-49 years], 4.1% [25-39 years], and 2.8% [15-24 years]; p-valve<0.0001). LTF was lower after vs. before ART initiation for all ages, with older adults experiencing less LTF than younger adults. Among 85,763 ART patients with baseline and follow-up CD4+ counts, adjusted average 12-month CD4+ response for older adults was 20.6 cells/mm3 lower than for adults 25-39 years of age (95% CI: 17.1-24.1).
  
  
  CONCLUSIONS
  The proportion of patients who are ≥50 years has increased over time and been driven by aging of the existing patient population. Older patients experienced less LTF, higher recorded mortality and less robust CD4+ response after ART initiation. Increased programmatic attention on older adults receiving HIV care in sub-Saharan Africa is warranted.
authors: Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, New York, United States of America.
authors: Eduard
authors: E
authors: Eduardo
authors: Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, New York, United States of America; ICAP, Mailman School of Public Health, Columbia University, New York, New York, United States of America.
authors: Matthew R
authors: MR
authors: Lamb
authors: ICAP, Mailman School of Public Health, Columbia University, New York, New York, United States of America.
authors: Sasi
authors: S
authors: Kandula
authors: Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, New York, United States of America; ICAP, Mailman School of Public Health, Columbia University, New York, New York, United States of America.
authors: Andrea
authors: A
authors: Howard
authors: ICAP, Mailman School of Public Health, Columbia University, New York, New York, United States of America.
authors: Veronicah
authors: V
authors: Mugisha
authors: National AIDS and STI Control Programme, Ministry of Health, Nairobi, Kenya.
authors: Davies
authors: D
authors: Kimanga
authors: National AIDS Control Program, Ministry of Health and Social Welfare, Dar es Salaam, Tanzania.
authors: Bonita
authors: B
authors: Kilama
authors: Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, New York, United States of America; ICAP, Mailman School of Public Health, Columbia University, New York, New York, United States of America.
authors: Wafaa
authors: W
authors: El-Sadr
authors: Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, New York, United States of America; ICAP, Mailman School of Public Health, Columbia University, New York, New York, United States of America.
authors: Batya
authors: B
authors: Elul
mesh_terms: D000293:Adolescent; D000328:Adult; D000554:Ambulatory Care Facilities; D019380:Anti-HIV Agents / Q000627:therapeutic use*; D018791:CD4 Lymphocyte Count; D005260:Female; D006078:Government Programs; D015658:HIV Infections / Q000188:drug therapy* / Q000453:epidemiology / Q000276:immunology; D006801:Humans; D007630:Kenya / Q000453:epidemiology; D059012:Lost to Follow-Up; D008297:Male; D008875:Middle Aged; D009073:Mozambique / Q000453:epidemiology; D012432:Rwanda / Q000453:epidemiology; D013636:Tanzania / Q000453:epidemiology; D016896:Treatment Outcome; D055815:Young Adult
chemical_list: D019380:Anti-HIV Agents