Risk of death among those awaiting treatment for HIV infection in Zimbabwe: adolescents are at particular risk |
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Authors: | Amir Shroufi Wedu Ndebele Mary Nyathi Hilary Gunguwo Mark Dixon Jean F Saint‐Sauveur Fabian Taziwa Mari C Violes Rashida A Ferrand |
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Institution: | 1.Médecins Sans Frontières, Harare, Zimbabwe;2.Mpilo OI/ART Clinic, Bulawayo, Zimbabwe;3.Faculty of Medicine, National University of Science and Technology, Bulawayo, Zimbabwe;4.Department of Clinical Research, London School of Hygiene and Tropical Medicine, London, UK |
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Abstract: | IntroductionMortality among HIV-positive adults awaiting antiretroviral therapy (ART) has previously been found to be high. Here, we compare adolescent pre-ART mortality to that of adults in a public sector HIV care programme in Bulawayo, Zimbabwe.MethodsIn this retrospective cohort study, we compared adolescent pre-ART outcomes with those of adults enrolled for HIV care in the same clinic. Adolescents were defined as those aged 10–19 at the time of registration. Comparisons of means and proportions were carried out using two-tailed sample t-tests and chi-square tests respectively, for normally distributed data, and the Mann–Whitney U-tests for non-normally distributed data. Loss to follow-up (LTFU) was defined as missing a scheduled appointment by three or more months.ResultsBetween 2004 and 2010, 1382 of 1628 adolescents and 7557 of 11,106 adults who registered for HIV care met the eligibility criteria for ART. Adolescents registered at a more advanced disease stage than did adults (83% vs. 73% WHO stage III/IV, respectively, p<0.001), and the median time to ART initiation was longer for adolescents than for adults 21 (10–55) days vs. 15 (7–42) days, p<0.001]. Among the 138 adolescents and 942 adults who never commenced ART, 39 (28%) of adolescents and 135 (14%) of adults died, the remainder being LTFU. Mortality among treatment-eligible adolescents awaiting ART was significantly higher than among adults (3% vs. 1.8%, respectively, p=0.004).ConclusionsAdolescents present to ART services at a later clinical stage than adults and are at an increased risk of death prior to commencing ART. Improved and innovative HIV case-finding approaches and emphasis on prompt ART initiation in adolescents are urgently needed. Following registration, defaulter tracing should be used, whether or not ART has been commenced. |
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Keywords: | HIV/AIDS ART adolescent pre-ART Africa |
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