title: Trends and determinants of survival for over 200 000 patients on antiretroviral treatment in the Botswana National Program: 2002-2013.
abstract: OBJECTIVE
  To determine the incidence and risk factors of mortality for all HIV-infected patients receiving antiretroviral treatment at public and private healthcare facilities in the Botswana National HIV/AIDS Treatment Programme.
  
  
  METHODS
  We studied routinely collected data from 226 030 patients enrolled in the Botswana National HIV/AIDS Treatment Programme from 2002 to 2013.
  
  
  METHODS
  A person-years (P-Y) approach was used to analyse all-cause mortality and follow-up rates for all HIV-infected individuals with documented antiretroviral therapy initiation dates. Marginal structural modelling was utilized to determine the effect of treatment on survival for those with documented drug regimens. Sensitivity analyses were performed to assess the robustness of our results.
  
  
  RESULTS
  Median follow-up time was 37 months (interquartile range 11-75). Mortality was highest during the first 3 months after treatment initiation at 11.79 (95% confidence interval 11.49-12.11) deaths per 100 P-Y, but dropped to 1.01 (95% confidence interval 0.98-1.04) deaths per 100 P-Y after the first year of treatment. Twelve-month mortality declined from 7 to 2% of initiates during 2002-2012. Tenofovir was associated with lower mortality than stavudine and zidovudine.
  
  
  CONCLUSIONS
  The observed mortality rates have been declining over time; however, mortality in the first year, particularly first 3 months of antiretroviral treatment, remains a distinct problem. This analysis showed lower mortality with regimens containing tenofovir compared with zidovudine and stavudine. CD4 cell count less than 100 cells/μl, older age and being male were associated with higher odds of mortality.
authors.affiliation: aHarvard T.H. Chan School of Public Health, Boston, Massachusetts, USA bMinistry of Health cUniversity of Botswana, Gaborone, Botswana dCenter for Disease Control and Prevention, Atlanta, Georgia, USA.
authors.forename: Mansour
authors.initials: M
authors.lastname: Farahani
authors.forename: Natalie
authors.initials: N
authors.lastname: Price
authors.forename: Shenaaz
authors.initials: S
authors.lastname: El-Halabi
authors.forename: Naledi
authors.initials: N
authors.lastname: Mlaudzi
authors.forename: Koona
authors.initials: K
authors.lastname: Keapoletswe
authors.forename: Refeletswe
authors.initials: R
authors.lastname: Lebelonyane
authors.forename: Ernest Benny
authors.initials: EB
authors.lastname: Fetogang
authors.forename: Tony
authors.initials: T
authors.lastname: Chebani
authors.forename: Poloko
authors.initials: P
authors.lastname: Kebaabetswe
authors.forename: Tiny
authors.initials: T
authors.lastname: Masupe
authors.forename: Keba
authors.initials: K
authors.lastname: Gabaake
authors.forename: Andrew
authors.initials: A
authors.lastname: Auld
authors.forename: Oathokwa
authors.initials: O
authors.lastname: Nkomazana
authors.forename: Richard
authors.initials: R
authors.lastname: Marlink
mesh_terms: D000328:Adult; D019380:Anti-HIV Agents / Q000627:therapeutic use; D001902:Botswana / Q000453:epidemiology; D005260:Female; D015658:HIV Infections / Q000188:drug therapy / Q000453:epidemiology* / Q000401:mortality*; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D012307:Risk Factors; D016019:Survival Analysis; D016896:Treatment Outcome
chemical_list: D019380:Anti-HIV Agents