This paper is being presented at the big AIDS conference in South Africa this week.
Why were the men sicker when they began? Is social science research being conducted? Do readers have ideas?
[him] moderator
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Gender differences and treatment outcomes from the largest antiretroviral treatment programme in Myanmar
K. Sabapathy1,2, M. Kyaw-Kyaw3, F. Smithuis3
1Medecins Sans Frontieres, Amsterdam, Netherlands, 2London School Hygiene and Tropical Medicine, London, United Kingdom, 3Medecins Sans Frontieres, Yangon, Myanmar
Background: HIV prevalence in Myanmar is approximately 1% and over 20,000 AIDS deaths occur annually. In 2003, Medecins Sans Frontieres pioneered ART provision and now delivers two-thirds of national ART coverage. Gender differences in survival on ART in resource limited settings (RLS) are often attributed to the lesser utilisation of healthcare and later presentation by men, especially in Africa. The objective of this study was to analyse the effect of gender differences on survival of ART patients in Myanmar.
Methods: Over 10,000 patients started ART in 13 sites in this programme. This analysis focused on 5 sites in Yangon. Baseline data collection included age, sex, BMI, WHO stage, and CD4 count. Survival analysis methods were used to estimate survival on ART of WHO stage 3 and 4 patients, stratified by gender.
Results: All 6332 patients ever registered for ART in Yangon project (2003-2008) were analysed, of whom 5682 were in WHO stage 3 and 4 and 59% were male. At baseline men were more commonly in WHO stage 4 (46% versus 33%, p < 0.001) and had lower median CD4 counts (67 c/mm3 versus 97 c/mm3, p < 0.001) than women. There were no differences in BMI (median 17.6, p=0.63). At 24-months, the probability of survival was 87% in men and 91% in women (log-rank test p < 0.001), with no difference in loss to follow-up (LTF) (3% versus 4%, p=0.45).
Conclusions: The programme has successfully scaled-up ART provision with survival and LTF data which compare favourably with other programs in RLS. The more advanced condition at baseline and lower probability of survival in men is interesting even though the proportion of men treated overall is higher. This likely reflects increased HIV prevalence and socio-economic barriers to earlier presentation of males in Myanmar. Targeted interventions to improve outcomes in men may be indicated.
http://www.ias2009.org/pag/Abstracts.aspx?AID=3385
