title: Improvement in mortality and retention among adult HIV-infected patients in the first 12 months of antiretroviral therapy in Dodoma urban district, Tanzania.
abstract: OBJECTIVE
  To determine mortality and retention in ART programmes in Tanzania, between 2010 and 2013.
  
  
  METHODS
  Retrospective routinely collected data were analysed from people starting ART in the period 2010-2013. Mortality and retention over the first 12 months on ART were compared across the 4 years, and adjustment was made for individual level potential confounders.
  
  
  RESULTS
  Data from 3844 people (70.6% female) starting ART were analysed. Mortality in the first year declined from 11.4% in 2010 to 4.9% in 2013, and retention after 12 months increased from 77.8% in 2010 to 98.1% in 2013. Mortality was inversely associated with CD4 count, lowest among those with CD4 350+ cells/μl [adjusted odds ratio (AOR) = 0.03, 95% CI 0.01-0.03], associated with male sex (AOR = 1.79, 95% CI 1.39-2.31), but not age. Lost to follow-up (LTFU) was lowest among those with CD4 = 350+ cells/μl AOR = 0.20, 95% CI 0.10-0.30), but not associated with age or sex, and higher in urban health facilities (AOR = 1.88, 95% CI 1.15-3.09). After adjustment for individual level characteristics, there was a statistically significant yearly improvement in mortality (AOR = 0.31, 95% CI (0.21-0.44) and LTFU (AOR = 0.06, 95% CI 0.04-0.10).
  
  
  CONCLUSIONS
  Mortality and retention in the first 12 months on ART have significantly improved over the 4 years from 2010 to 2013. These improvements may indicate better services, earlier initiation on ART, and strengthened systems to provide ART in Tanzania. These results refute the worries that earlier initiation on ART might lead to lower retention in the ART programme.
authors.affiliation: Mirembe Hospital, Dodoma, Tanzania; Kilimanjaro Christian Medical University College, Moshi, Tanzania.
authors.forename: Escor N
authors.initials: EN
authors.lastname: Tweve
authors.forename: David
authors.initials: D
authors.lastname: Kayabu
authors.forename: Nahum O
authors.initials: NO
authors.lastname: Nassari
authors.forename: Jim
authors.initials: J
authors.lastname: Todd
mesh_terms: D000293:Adolescent; D000328:Adult; D019380:Anti-HIV Agents / Q000627:therapeutic use*; D018791:CD4 Lymphocyte Count; D005260:Female; D015658:HIV Infections / Q000188:drug therapy* / Q000401:mortality*; D006801:Humans; D059012:Lost to Follow-Up; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D012307:Risk Factors; D015996:Survival Rate; D013636:Tanzania / Q000453:epidemiology; D013997:Time Factors; D016896:Treatment Outcome; D014505:Urban Population; D016903:Drug Monitoring
chemical_list: D019380:Anti-HIV Agents
keywords: HIV-infected patients; Tanzania; Tanzanie; antiretroviral therapy; mortalidad; mortality; mortalité; pacientes infectados con VIH; patients infectés par le VIH; retención; retention; rétention; terapia antirretroviral; traitement antirétroviral