Evaluation of 9 Years of National Antiretroviral Treatment in Botswana
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Washington D.C., USA, 22-27 July 2012 www.aids2012.org EVALUATION OF 9 YEARS OF NATIONAL ANTIRETROVIRAL TREATMENT IN BOTSWANA Richard Marlink, MD Mansour Farahani MD,MPH, ScD
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Richard Marlink, MD Mansour Farahani MD,MPH, ScD. Evaluation of 9 Years of National Antiretroviral Treatment in Botswana. Data management. Total number of adult patients in dataset (n=142,611) (1,894,396 observations). - PowerPoint PPT Presentation
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Evaluation of 9 Years of National Antiretroviral Treatment in Botswana
Richard Marlink, MDMansour Farahani MD,MPH, ScD
Washington D.C., USA, 22-27 July 2012www.aids2012.org1Washington D.C., USA, 22-27 July 2012www.aids2012.orgTotal number of adult patients in dataset(n=142,611)(1,894,396 observations)1,144 patients removed for having an observation after the recorded death924 patients removed without information for medication, death or CD4295 patients removed because of inconsistency in the data14,272 patients removed with only 1 observation in the data Adults available for survival analysis(n=125,976)Had info for regression analysis(n= 99,217 )Had baseline CD4 cell count for regression analysis(n= 67,318)Had ART regimen info for regression analysis(n=102,713)Data management Washington D.C., USA, 22-27 July 2012www.aids2012.orgSummary stat.Sample size (adult) 125,976Median follow-up visits 11 (IQR, 6 to 21)Died in the 1st year of treatment3,349 Public-Private Partnership 6,484(5%) Overall Death10,230 (8.1%)Female 62.5%Washington D.C., USA, 22-27 July 2012www.aids2012.org4Study PopulationBaselineCD4 more than250CD4 less than 250 CD4 missingTotalSurvival8,52156,32630,59995,446Death3134,6922,2627,267Total8,83461,01832,861102,713CD4 is the baseline CD4.Washington D.C., USA, 22-27 July 2012www.aids2012.orgSummary stat.MeanSt. Dev.Min.MaxAge3791864Days on treatment10407168 2,968Baseline cd4156960500Baseline Medicationsample proportionZDV77%d4t8%TDF15%EFV55%NVP43%Switched nrti13%Swithced nnrti5.3%Washington D.C., USA, 22-27 July 2012www.aids2012.org6Washington D.C., USA, 22-27 July 2012www.aids2012.orgWashington D.C., USA, 22-27 July 2012www.aids2012.orgSummary stat.Total follow-up time 281067.34 P-YTotal number of death (on treatment) 7257 Overall mortality rate 25.8 (1000 P-Y)Washington D.C., USA, 22-27 July 2012www.aids2012.org9Mortality rate (1000 P-Y) in Masa programWashington D.C., USA, 22-27 July 2012www.aids2012.org10Mortality rate in the first year in Masa ProgramWashington D.C., USA, 22-27 July 2012www.aids2012.org
Washington D.C., USA, 22-27 July 2012www.aids2012.org12Logistic model: probability of deathVariableAll patients on treatmentPatients with baseline CD4 ZDV0.951.03d4t1.48***1.40***TDF--EFV1.071.09NVP--If Age >40 (dummy)1.15***1.16***Age >40 (continuous) 1.02*** 1.02***female0.81***0.86***Switched NRTI2.35***2.36***Switched NNRTI 1.30*** 1.29***Pre-treatment follow-up (quarters) 0.92***0.93*** Treatment follow-up (quarters)0.73***0.72*** 2002 7.31* 9.43* 20033.42*** 2.95*** 2004--2005 0.78*** 0.91 2006 0.51*** 0.58***2007 0.25*** 0.27*** 2008 0.11*** 0.12*** 20090.03*** 0.03*** 2010 0.004*** 0.005*** Baseline cd4 0-50--Baseline cd4 50-150-0.64***Baseline cd4 150-250-0.41***Baseline cd4 more than 250-0.45***Sample size 99,21767.318Level of statistical significance: * 0.1 **0.05 ***0.001Washington D.C., USA, 22-27 July 2012www.aids2012.org13Findings summaryOverall mortality has dropped over the life of the programHigher mortality in the first 6 monthsProgram sees to improve over timeNo significant advantage for TDF over ZDV or EFV over NVP
Washington D.C., USA, 22-27 July 2012www.aids2012.orgDisparity in the MASA ProjectWashington D.C., USA, 22-27 July 2012www.aids2012.org15MASA Data by District
Washington D.C., USA, 22-27 July 2012www.aids2012.orgPopulation DemographicsAbout 60% of the patients were female across all districtsThe mean age at treatment initiation was between 36 and 38 Washington D.C., USA, 22-27 July 2012www.aids2012.org17Proportion of Deaths by number of Patients in DistrictWashington D.C., USA, 22-27 July 2012www.aids2012.orgProportion of LTFUs by number of Patients in DistrictWashington D.C., USA, 22-27 July 2012www.aids2012.orgDuration of treatment follow-upWashington D.C., USA, 22-27 July 2012www.aids2012.orgChanges in CD4 over time, by District
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Washington D.C., USA, 22-27 July 2012www.aids2012.org22Survival Model
Washington D.C., USA, 22-27 July 2012www.aids2012.org23Graphic life tables
Washington D.C., USA, 22-27 July 2012www.aids2012.org24Graphic life tables
Washington D.C., USA, 22-27 July 2012www.aids2012.org25Adjusted* Odds Ratios for Death & Loss to Follow Up by District; Ref = Gaborone*Adjusted for: gender, age, baseline CD4, quarters of observation before treatment initiated, quarters of observation after treatment initiated, medications at treatment initiation, switch of nrti or nnrti medications, and year treatment was initiated (ref = 2004)** Outliers excluded: Mabusane & Kgatleng OR for Death 2.0 and 2.4, respectively, and OR for Loss to Follow Up 34.7 and 17.3, respectively. All OR are significantly different than Gaborone except ORs for death in Chobe . Washington D.C., USA, 22-27 July 2012www.aids2012.org26
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Washington D.C., USA, 22-27 July 2012www.aids2012.orgFindings summaryWide variation in Masa patients mortality rate and LTFU among the health districts (even at major urban centers)Difference in probability of mortality for two patients with the same age, gender, regimen and status of disease in different towns are statistically significant.Cause(s) to be further investigated.
Washington D.C., USA, 22-27 July 2012www.aids2012.org
