Background
Methods
The IeDEA West Africa collaboration
Inclusion criteria
Ethical aspects
Outcomes
Statistical analysis
Results
Description of sites
Country | Site | Electronic files or medical records | Location | Sector (public/private) | Free access to ART | Free access to cotrimoxazole | Free access to lab exams* | Availability of tracing methods for loss to follow-up** |
---|---|---|---|---|---|---|---|---|
Benin
| Hôpital d'Instruction des Armées, Cotonou (UPEIV) | Electronic | Urban | Private | Yes | Yes | Yes | Yes |
Côte d'Ivoire
| Centre de Prise en charge, de Recherche et de Formation (CEPREF), Abidjan | Electronic | Urban | Public | Yes | Yes | Yes | Yes |
Côte d'Ivoire
| MTCT Plus Network, Abidjan | Electronic | Urban | Public | Yes | Yes | Yes | Yes |
Côte d'Ivoire
| CHU de Yopougon, Abidjan | Electronic | Urban | Public | Yes | Yes | Yes | Yes |
Côte d'Ivoire
| CIRBA | Electronic | Urban | Semi-public | Yes | Yes | Yes | No |
Gambia
| Medical Research Council, Fajara | Medical records | Urban | Public | Yes | Yes | Yes | No |
Ghana
| Korle Bu Hospital, Accra (KBTH) | Medical records | Urban | Public | No | No | Yes | No |
Senegal
| Hôpital d'Enfants Albert-Royer, Dakar | Medical records | Urban | Public | Yes | Yes | Yes | Yes |
Mali
| Hôpital Gabriel Touré, Bamako | Electronic | Urban | Public | Yes | Yes | Yes | No |
Site | N | Girl (%) | Median Age (years) (IQR) | %AIDS or clinical stage IV (%Missing) | Initial ART regimen (%) | Median CD4 cell count (IQR) | Median CD4 percent (IQR) | %Immuno-supression* (%Missing) | %CTX Status$ (%Missing) | Year of ART initiation | ||||
---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
2NRTI+1NNRTI | 2NRTI +1 PI | Others | ≤ 2004 | 2005 | ≥ 2006 | |||||||||
UPEIV
| 71 | 46.5 | 4 (2-7) | 24.3 (1.4) | 0.0 | 100.0 | 0.0 | 291 (132-517) | 8(5-12) | 89.9 (2.8) | 100.0 (1.4) | 50.7 | 19.7 | 29.6 |
CEPREF
| 306 | 42.5 | 6 (3-9) | 20.2 (1.6) | 63.1 | 33.3 | 3.6 | 356 (106-728) | 11 (6-16) | 79.5 (15.4) | 32.8 (0.3) | 12.7 | 50.7 | 36.6 |
MTCT Plus
| 74 | 52.7 | 2 (1-4) | 10.3 (21.6) | 35.1 | 64.9 | 0.0 | 858 (437-1285) | 18 (14-24) | 57.7 (4.1) | 89.7 (21.6) | 41.9 | 23.0 | 35.1 |
CHU Yopougon
| 650 | 48.3 | 6(3-10) | 0.5 (4.0) | 46.0 | 53.5 | 0.5 | 445 (201-738) | 14(7-21) | 60.1 (14.5) | 15.6 (0.6) | 52.3 | 24.2 | 23.5 |
CIRBA
| 141 | 47.5 | 4 (2-7) | 53.3 (5.1) | 66.7 | 31.9 | 1.4 | 393 (227-947) | 14 (6-20) | 72.0 (46.8) | 71.2 (48.2) | 13.5 | 19.9 | 66.7 |
FAJARA
| 23 | 47.8 | 6 (4-12) | - (100.0) | 82.6 | 13.0 | 4.3 | 305 (220-580) | 15 (9-19) | 50.0 (4.3) | - (100.0) | 4.3 | 34.8 | 60.9 |
KBTH
| 128 | 47.7 | 6 (3-8) | 3.9 (0.0) | 96.9 | 0.0 | 3.1 | 332 (77-684) | 11 (4-17) | 65.6 (25.0) | 93.8 (0.0) | 11.7 | 51.6 | 36.7 |
Albert Royer
| 104 | 43.3 | 7 (4-10) | 55.3 (1.0) | 81.7 | 15.4 | 2.9 | 340 (31-610) | 9 (4-15) | 63.9 (41.3) | 92.3 (0.0) | 32.7 | 20.2 | 47.1 |
Gabriel Toure
| 673 | 40.4 | 4 (2-8) | 30.4 (2.2) | 75.2 | 23.0 | 1.8 | 335 (115-602) | - | 55.8 (16.3) | - (100.0) | 39.8 | 18.0 | 42.2 |
Total
|
2170
|
44.8
|
5 (2-9)
|
19.1 (13.2)
|
62.0
|
36.3
|
1.7
|
385 (142-691)
|
13 (7-19)
|
63.4 (18.3)
|
42.7 (36.2)
|
36.0
|
27.1
|
36.9
|
Characteristics of patients and antiretroviral regimens at ART initiation
Mortality rate and loss-to-program
Death | Loss to follow-up | Loss to program (death and lost to follow-up) | ||||||||||
---|---|---|---|---|---|---|---|---|---|---|---|---|
Month-6 | Month-12 | Month-6 | Month-12 | Month-6 | Month-12 | |||||||
Age at ART initiation | n | Probability (95% CI) | n | Probability (95% CI) | n | Probability (95% CI) | n | Probability (95% CI) | n | Probability (95% CI) | n | Probability (95% CI) |
< 12 months
| 36 | 8.9 (3.4; 22.2) | 23 | 11.7 (5.0; 26.0) | 36 | 0.0 (0.0; 0.0) | 23 | 20.2 (10.2; 37.8) | 36 | 8.9 (3.4;.22.2) | 23 | 29.8 (18.0; 46.6) |
1-3 years
| 398 | 10.6 (8.2; 13.7) | 278 | 12.7 (10.0; 16.1) | 398 | 5.0 (3.4; 7.3) | 278 | 19.4 (15.8; 23.7) | 398 | 15.1 (12.2; 18.5) | 278 | 29.7 (25.7; 34.1) |
3-5 years
| 341 | 3.7 (2.2; 6.2) | 262 | 5.2 (3.4; 8.1) | 341 | 2.4 (1.2; 4.6) | 262 | 15.9 (12.3; 20.3) | 341 | 6.0 (4.0; 8.9) | 262 | 20.3 (16.5; 24.9) |
5-10 years
| 629 | 5.6 (4.2; 7.5) | 516 | 7.1 (5.4; 9.2) | 629 | 4.2 (3.0; 6.0) | 516 | 13.8 (11.4; 16.8) | 629 | 9.6 (7.7; 12.0) | 516 | 19.9 (17.1; 23.1) |
≥ 10 years
| 376 | 6.2 (4.3; 8.9) | 294 | 8.1 (5.9; 11.2) | 376 | 4.3 (2.7; 6.7) | 294 | 15.8 (12.5; 19.9) | 376 | 10.2 (7.7; 13.5) | 294 | 22.7 (18.9; 27.0) |
Factors associated with death or loss-to-program
Univariate analysis | Multivariate analysis | |||||
---|---|---|---|---|---|---|
HR* | 95% CI |
P
| aHR | 95% CI |
P
| |
Sex
| ||||||
Boys | 1 | - | - | 1 | - | - |
Girls | 1.1 | 0.7-1.5 | 0.72 | 1.0 | 0.7-1.4 | 0.88 |
Age at ART initiation
| ||||||
10 years and plus | 1 | - | - | 1 | - | - |
[5-10] years | 0.8 | 0.5-1.4 | 0.49 | 0.9 | 0.5-1.5 | 0.70 |
[3-5] years | 0.6 | 0.3-1.2 | 0.15 | 0.9 | 0.5-1.7 | 0.68 |
[1-3] years | 1.5 | 0.9-2.6 | 0.12 | 1.2 | 0.7-2.1 | 0.40 |
< 12 months | 1.2 | 0.4-4.3 | 0.69 | 1.1 | 0.3-3.8 | 0.79 |
ART regimen at baseline
| ||||||
2 NRTI+1 NNRTI | 1 | - | - | 1 | ||
2 NRTI+1 PI | 0.7 | 0.4-1.0 | 0.06 | 0.9 | 0.6-1.5 | 0.76 |
Other | 0.2 | 0.02-2.6 | 0.21 | 1.0 | 0.2-5.0 | 0.98 |
Clinical stage at ART initiation
| ||||||
A, B or I, II, III | 1 | - | - | 1 | - | - |
AIDS or IV | 6.0 | 3.9-9.2 | < 0.01 | 2.5 | 1.6-3.9 | < 0.01 |
Unknown | 0.9 | 0.4-2.0 | 0.90 | 1.4 | 0.7-2.9 | 0.29 |
% CD4 at ART initiation
| ||||||
≥ 15% | 1 | - | - | 1 | - | - |
< 15% | 2.1 | 1.1-3.9 | 0.02 | 2.1 | 1.1-4.1 | 0.03 |
Missing | 1.5 | 0.7-3.3 | 0.22 | 1.5 | 0.6-3.6 | 0.27 |
Year of ART initiation
| ||||||
≤ 2004 | 1 | - | - | 1 | - | - |
2005 | 1.8 | 1.0-3.0 | 0.03 | 1.7 | 1.0-2.9 | 0.04 |
≥ 2006 | 2.6 | 1.7-4.2 | < 0.01 | 2.8 | 1.7-4.7 | < 0.01 |
Initiation of cotrimoxazole at ART initiation
| ||||||
No | 1 | - | - | 1 | - | - |
Yes | 1.3 | 0.7-2.5 | 0.39 | 0.9 | 0.5-1.7 | 0.67 |
Missing | 0.6 | 0.1-3.1 | 0.50 | 0.4 | 0.1-2.3 | 0.30 |
Univariate analysis | Multivariate analysis | |||||
---|---|---|---|---|---|---|
HR* | CI (95%)** |
P
| aHR | CI (95%)** |
P
| |
Sex
| ||||||
Boys | 1 | - | - | 1 | - | - |
Girls | 1.0 | 0.8-1.3 | 0.72 | 1.0 | 0.8-1.2 | 0.78 |
Age at ART initiation
| ||||||
10 years and plus | 1 | - | - | 1 | - | - |
[5-10] years | 0.9 | 0.6-1.2 | 0.32 | 0.9 | 0.7-1.3 | 0.56 |
[3-5] years | 0.8 | 0.5-1.2 | 0.22 | 0.9 | 0.6-1.3 | 0.52 |
[1-3] years | 1.3 | 0.9-1.8 | 0.10 | 1.1 | 0.8-1.6 | 0.34 |
< 12 months | 1.4 | 0.6-2.9 | 0.36 | 1.1 | 0.5-2.4 | 0.66 |
ART regimen at baseline
| ||||||
2 NRTI+1 NNRTI | 1 | - | - | 1 | ||
2 NRTI+1 IP | 0.7 | 0.5-0.9 | 0.01 | 0.9 | 0.7-1.2 | 0.62 |
Other | 0.6 | 0.2-1.5 | 0.24 | 1.0 | 0.4-2.5 | 0.98 |
Clinical stage at ART initiation
| ||||||
A, B or I, II, III | 1 | - | - | 1 | - | - |
AIDS or IV | 2.6 | 2.0-3.5 | < 0.01 | 2.3 | 1.7-3.0 | < 0.01 |
Unknown | 1.3 | 0.8-2.1 | 0.21 | 1.4 | 0.9-2.3 | 0.15 |
% CD4 at ART initiation
| ||||||
≥ 15% | 1 | - | - | 1 | - | - |
< 15% | 2.1 | 1.4.3.2 | < 0.01 | 1.9 | 1.3-2.9 | < 0.01 |
Missing | 1.5 | 0.9-2.5 | 0.07 | 1.7 | 1.1-2.8 | 0.03 |
Year of ART initiation
| ||||||
≤ 2004 | 1 | - | - | 1 | - | - |
2005 | 2.0 | 1.5-2.7 | < 0.01 | 1.7 | 1.3-2.4 | < 0.01 |
≥ 2006 | 3.5 | 2.6-4.6 | < 0.01 | 3.0 | 2.2-4.0 | < 0.01 |
Cotrimoxazole status at ART initiation
| ||||||
No | 1 | - | - | 1 | - | - |
Yes | 1.2 | 0.7-1.8 | 0.43 | 0.9 | 0.6-1.4 | 0.63 |
Missing | 0.6 | 0.2-1.8 | 0.32 | 0.4 | 0.1-1.5 | 0.16 |