title: Gender-related differences in outcomes and attrition on antiretroviral treatment among an HIV-infected patient cohort in Zimbabwe: 2007-2010.
abstract: OBJECTIVE
  To determine (1) gender-related differences in antiretroviral therapy (ART) outcomes, and (2) gender-specific characteristics associated with attrition.
  
  
  METHODS
  This was a retrospective patient record review of 3919 HIV-infected patients aged ≥15 years who initiated ART between 2007 and 2009 in 40 randomly selected ART facilities countrywide.
  
  
  RESULTS
  Compared to females, males had more documented active tuberculosis (12% vs. 9%; p<0.02) and a lower median CD4 cell count (117 cells/μl vs. 143 cells/μl; p<0.001) at ART initiation. Males had a higher risk of attrition (adjusted hazard ratio (AHR) 1.28, 95% confidence interval (CI) 1.10-1.49) and mortality (AHR 1.56, 95% CI 1.10-2.20). Factors associated with attrition for both sexes were lower baseline weight (<45kg and 45-60kg vs. >60kg), initiating ART at an urban health facility, and care at central/provincial or district/mission hospitals vs. primary healthcare facilities.
  
  
  CONCLUSIONS
  Our findings show that males presented late for ART initiation compared to females. Similar to other studies, males had higher patient attrition and mortality compared to females and this may be attributed in part to late presentation for HIV treatment and care. These observations highlight the need to encourage early HIV testing and enrolment into HIV treatment and care, and eventually patient retention on ART, particularly amongst men.
authors.affiliation: AIDS and TB Unit, Ministry of Health and Child Care, PO Box CY 1122, Causeway, Harare, Zimbabwe; International Union Against Tuberculosis and Lung Disease, Paris, France. Electronic address: ktakarinda@theunion.org.
authors.forename: Kudakwashe C
authors.initials: KC
authors.lastname: Takarinda
authors.affiliation: International Union Against Tuberculosis and Lung Disease, Paris, France; Department of Clinical Research, London School of Hygiene and Tropical Medicine, London, UK.
authors.forename: Anthony D
authors.initials: AD
authors.lastname: Harries
authors.affiliation: Division of Global HIV/AIDS, Center for Global Health, Centers for Disease Control and Prevention (CDC), Atlanta, GA, USA.
authors.forename: Ray W
authors.initials: RW
authors.lastname: Shiraishi
authors.affiliation: AIDS and TB Unit, Ministry of Health and Child Care, PO Box CY 1122, Causeway, Harare, Zimbabwe.
authors.forename: Tsitsi
authors.initials: T
authors.lastname: Mutasa-Apollo
authors.affiliation: Division of Global HIV/AIDS, Center for Global Health, Centers for Disease Control and Prevention (CDC), Atlanta, GA, USA.
authors.forename: Abu
authors.initials: A
authors.lastname: Abdul-Quader
authors.affiliation: AIDS and TB Unit, Ministry of Health and Child Care, PO Box CY 1122, Causeway, Harare, Zimbabwe.
authors.forename: Owen
authors.initials: O
authors.lastname: Mugurungi
mesh_terms: D000293:Adolescent; D000328:Adult; D019380:Anti-HIV Agents / Q000627:therapeutic use*; D015331:Cohort Studies; D005260:Female; D015658:HIV Infections / Q000188:drug therapy* / Q000453:epidemiology / Q000276:immunology / Q000401:mortality; D006801:Humans; D015994:Incidence; D059012:Lost to Follow-Up; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D012737:Sex Factors; D016896:Treatment Outcome; D055815:Young Adult; D015030:Zimbabwe
chemical_list: D019380:Anti-HIV Agents
keywords: Antiretroviral therapy; Attrition; Gender differences; HIV mortality; Zimbabwe