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Title
Monitoring of antiretroviral therapy and mortality in HIV programmes in Malawi, South Africa and Zambia: mathematical modelling study |
Full text
http://hdl.handle.net/11427/14990; http://dx.doi.org/10.1371/journal.pone.0057611 |
Date
2013 |
Author(s)
Estill, Janne; Egger, Matthias; Johnson, Leigh F; Gsponer, Thomas; Wandeler, Gilles; Davies, Mary-Ann; Boulle, Andrew; Wood, Robin; Garone, Daniela; Stringer, Jeffrey S A |
Abstract
Objectives Mortality in patients starting antiretroviral therapy (ART) is higher in Malawi and Zambia than in South Africa. We examined whether different monitoring of ART (viral load [VL] in South Africa and CD4 count in Malawi and Zambia) could explain this mortality difference. Design: Mathematical modelling study based on data from ART programmes. METHODS: We used a stochastic simulation model to study the effect of VL monitoring on mortality over 5 years. In baseline scenario A all parameters were identical between strategies except for more timely and complete detection of treatment failure with VL monitoring. Additional scenarios introduced delays in switching to second-line ART (scenario B) or higher virologic failure rates (due to worse adherence) when monitoring was based on CD4 counts only (scenario C). Results are presented as relative risks (RR) with 95% prediction intervals and percent of observed mortality difference explained. RESULTS: RRs comparing VL with CD4 cell count monitoring were 0.94 (0.74-1.03) in scenario A, 0.94 (0.77-1.02) with delayed switching (scenario B) and 0.80 (0.44-1.07) when assuming a 3-times higher rate of failure (scenario C). The observed mortality at 3 years was 10.9% in Malawi and Zambia and 8.6% in South Africa (absolute difference 2.3%). The percentage of the mortality difference explained by VL monitoring ranged from 4% (scenario A) to 32% (scenarios B and C combined, assuming a 3-times higher failure rate). Eleven percent was explained by non-HIV related mortality. CONCLUSIONS: VL monitoring reduces mortality moderately when assuming improved adherence and decreased failure rates. |
Subject(s)
Antiretroviral therapy; Death rates; Viral load; Mathematical models; HIV |
Language
eng |
Publisher
Public Library of Science; University of Cape Town; Faculty of Health Sciences; Institute of Infectious Disease & Molecular Medicine |
Type of publication
Article |
Source
PLoS One; http://journals.plos.org/plosone |
Rights
http://creativecommons.org/licenses/by/4.0; © 2013 Estill et al; This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited. |
Identifier
Estill, J., Egger, M., Johnson, L. F., Gsponer, T., Wandeler, G., Davies, M. A., ... & Keiser, O. (2012). Monitoring of antiretroviral therapy and mortality in HIV programmes in Malawi, South Africa and Zambia: mathematical modelling study. PloS one, 8(2), e57611-e57611. doi:10.1371/journal.pone.0057611 |
Repository
Cape Town - OpenUCT, University of Cape Town
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Added to C-A: 2016-11-03;08:34:45 |
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