Myanmar needs more clinical research like this. If one of the authors sends the [him] moderator the paper he will post it.
[him] moderator
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Treatment outcomes from the largest antiretroviral treatment programme in Myanmar (Burma): a cohort analysis of retention after scale-up.
J Acquir Immune Defic Syndr. 2012 Feb 13;
Authors: Sabapathy K, Ford N, Chan KN, Kyaw MK, Elema R, Smithuis F, Floyd S
Abstract
BACKGROUND: Antiretroviral treatment (ART) coverage in Myanmar is well below average.This study describes retention and baseline predictors of prognosis from the largest ART programme in the country.
METHODS: A cohort analysis of adult patients who initiated ART during 2003-2007 was conducted, with follow-up until the end of 2009. The primary outcome was attrition (death plus losses-to-follow-up (LTF)). Baseline variables were assessed as potential risk-factors. The cumulative probabilities of death, LTF and attrition up to 5-years were described using Kaplan-Meier estimates. Cox-regression was used to calculate hazard ratios of attrition, overall and separately for two time-periods on ART: 1-6months and 7-36months.
RESULTS: 5,963 adults enrolled in the programme, providing 17,581 person-years of follow-up.Median age at baseline was 33-years(IQR:28-38), 61% were male, 45% were in WHO Stage-IV and the median CD4-count was 71 cells/mm3 (IQR:29-164). There were 821(13.8%) deaths and 389(6.5%) LTF over the study period, with a 72% probability of being retained in care in the 5 year cohort. Double the rate of loss was contributed by death compared to LTF and attrition was almost four times higher in the period 1-6months compared to 7-36months.In the multivariable analyses of the programme overall, older age (aHR:1.56, 95%CI:1.25,1.94), male gender (aHR:1.52, 95%CI:1.25,1.85), WHO stage-IV (aHR:1.44, 95%CI:1.19,1.74) and BMI <16/kg/mm2(aHR:2.13, 95%CI:1.71,2.66) were independently predictive of attrition.
CONCLUSIONS: The excellent retention over more than 6-years in this large cohort demonstrate that ART delivery at the primary-care level in Myanmar is feasible and should encourage support for further ART expansion in the country.
PMID: 22334069 [PubMed - as supplied by publisher]
