title: Trends in one-year cumulative incidence of death between 2005 and 2013 among patients initiating antiretroviral therapy in Uganda.
abstract: Recent ecological data demonstrate improving outcomes for HIV-infected people in sub-Saharan Africa. Recently, Uganda has experienced a resurgence in HIV incidence and prevalence, but trends in HIV-related deaths have not been well described. Data were collected through the Uganda AIDS Rural Treatment Outcomes (UARTO) Study, an observational longitudinal cohort of Ugandan adults initiating antiretroviral therapy (ART) between 2005 and 2013. We calculated cumulative incidence of death within one year of ART initiation, and fit Poisson models with robust variance estimators to estimate the effect enrollment period on one-year risk of death and loss to follow-up. Of 760 persons in UARTO who started ART, 30 deaths occurred within one year of ART initiation (cumulative incidence 3.9%, 95% confidence interval [CI] 2.7-5.6%). Risk of death was highest for those starting ART in 2005 (13.0%, 95% CI 6.0-24.0%), decreased in 2006-2007 to 4% (95% CI 2.0-6.0%), and did not change thereafter ( P = 0.61). These results were robust to adjustment for age, sex, CD4 cell count, viral load, asset wealth, baseline depression, and body mass index. Here, we demonstrate that one-year cumulative incidence of death was high just after free ART rollout, decreased the following year, and remained low thereafter. Once established, ART programs in President's Emergency Fund for AIDS Relief-supported countries can maintain high quality care.
authors.affiliation: 1 Division of Infectious Diseases, Massachusetts General Hospital, Boston, MA, USA.|2 Massachusetts General Hospital Center for Global Health, Boston, MA, USA.
authors.forename: Lisa M
authors.initials: LM
authors.lastname: Bebell
authors.affiliation: 1 Division of Infectious Diseases, Massachusetts General Hospital, Boston, MA, USA.|2 Massachusetts General Hospital Center for Global Health, Boston, MA, USA.
authors.forename: Mark J
authors.initials: MJ
authors.lastname: Siedner
authors.affiliation: 3 Mbarara University of Science and Technology, Mbarara, Uganda.
authors.forename: Nicholas
authors.initials: N
authors.lastname: Musinguzi
authors.affiliation: 3 Mbarara University of Science and Technology, Mbarara, Uganda.|4 Epicentre Research Base, Mbarara, Uganda.
authors.forename: Yap
authors.initials: Y
authors.lastname: Boum
authors.affiliation: 3 Mbarara University of Science and Technology, Mbarara, Uganda.
authors.forename: Bosco M
authors.initials: BM
authors.lastname: Bwana
authors.affiliation: 5 Department of Medicine, Mbarara Regional Referral Hospital, Mbarara, Uganda.
authors.forename: Winnie
authors.initials: W
authors.lastname: Muyindike
authors.affiliation: 6 Department of Medicine, University of California, Berkeley, CA, USA.
authors.forename: Peter W
authors.initials: PW
authors.lastname: Hunt
authors.affiliation: 7 Department of Epidemiology and Biostatistics, University of California, Berkeley, CA, USA.
authors.forename: Jeffrey N
authors.initials: JN
authors.lastname: Martin
authors.affiliation: 1 Division of Infectious Diseases, Massachusetts General Hospital, Boston, MA, USA.|2 Massachusetts General Hospital Center for Global Health, Boston, MA, USA.
authors.forename: David R
authors.initials: DR
authors.lastname: Bangsberg
mesh_terms: D000328:Adult; D019380:Anti-HIV Agents / Q000008:administration & dosage*; D023241:Antiretroviral Therapy, Highly Active; D018791:CD4 Lymphocyte Count; D015658:HIV Infections / Q000188:drug therapy* / Q000401:mortality; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D009026:Mortality / Q000639:trends*; D016896:Treatment Outcome; D014454:Uganda / Q000453:epidemiology; D019562:Viral Load
chemical_list: D019380:Anti-HIV Agents
keywords: Africa; Death; HIV; antiretroviral; antiretroviral therapy; clinical outcomes; early; mortality