PLoS Medicine
Public Library of Science
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Mortality estimates by age and sex among persons living with HIV after ART initiation in Zambia using electronic medical records supplemented with tracing a sample of lost patients: A cohort study
Volume: 17, Issue: 5
DOI 10.1371/journal.pmed.1003107
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Abstract

Why was this study done?Despite many studies demonstrating differences in HIV-related outcomes between men and women on antiretroviral therapy (ART) in sub-Saharan Africa, few studies use a probability sample that would enable them to offer regionally representative estimates.Many studies taken from routine service delivery settings are unable to account for outcomes among individuals lost to follow-up, which may threaten the validity of estimates comparing mortality in men and women.Furthermore, whether differences in survival between men and women vary across other important sociodemographic characteristics (such as age) remains underexplored.What did the researchers do and find?We used a multistage sampling approach to enumerate an analysis population of HIV-positive patients visiting public health facilities in 4 provinces in Zambia (Lusaka, Southern, Eastern, and Western).We estimated the association between sex and mortality overall and by age, adjusting for other sociodemographic and clinical characteristics.Of 49,129 adults newly initiating ART, the mortality rate was almost twice as high in men compared to women.Analysis of age-by-sex interactions revealed particularly elevated mortality among young males (as compared to females of the same age). While mortality rates appeared to fall with age among men, mortality rates rose with age among women, and by 50 years of age, women had a 2–3 times higher rate of death compared to women under 30.What do these findings mean?Among adults living with HIV in Zambia, men on average experience greater mortality compared to women, but this difference varies markedly by age, even after adjustment for other sociodemographic and clinical characteristics (e.g., baseline level of immunosuppression).Additional means of engaging and supporting younger men in HIV care is urgently needed and may include improved access to self-testing, use of financial incentives, and male-friendly services that feature flexible hours, an integrated multi-disease care model, and reduced visit frequency.Rising mortality associated with age in women greater than would be expected in the general population suggests that health services targeting women of reproductive age may be in part responsible for good clinical outcomes in younger women, but also highlights the need for specific programs to engage older women in care.

https://www.researchpad.co/tools/openurl?pubtype=article&doi=10.1371/journal.pmed.1003107&title=Mortality estimates by age and sex among persons living with HIV after ART initiation in Zambia using electronic medical records supplemented with tracing a sample of lost patients: A cohort study&author=Andrew D. Kerkhoff,Kombatende Sikombe,Ingrid Eshun-Wilson,Izukanji Sikazwe,David V. Glidden,Jake M. Pry,Paul Somwe,Laura K. Beres,Sandra Simbeza,Chanda Mwamba,Chama Bukankala,Cardinal Hantuba,Carolyn Bolton Moore,Charles B. Holmes,Nancy Padian,Elvin H. Geng,Nicola Low,&keyword=&subject=Research Article,Biology and Life Sciences,Population Biology,Population Metrics,Death Rates,Biology and Life Sciences,Microbiology,Medical Microbiology,Microbial Pathogens,Viral Pathogens,Immunodeficiency Viruses,HIV,Medicine and Health Sciences,Pathology and Laboratory Medicine,Pathogens,Microbial Pathogens,Viral Pathogens,Immunodeficiency Viruses,HIV,Biology and Life Sciences,Organisms,Viruses,Viral Pathogens,Immunodeficiency Viruses,HIV,Biology and Life Sciences,Organisms,Viruses,Immunodeficiency Viruses,HIV,Biology and life sciences,Organisms,Viruses,RNA viruses,Retroviruses,Lentivirus,HIV,Biology and Life Sciences,Microbiology,Medical Microbiology,Microbial Pathogens,Viral Pathogens,Retroviruses,Lentivirus,HIV,Medicine and Health Sciences,Pathology and Laboratory Medicine,Pathogens,Microbial Pathogens,Viral Pathogens,Retroviruses,Lentivirus,HIV,Biology and Life Sciences,Organisms,Viruses,Viral Pathogens,Retroviruses,Lentivirus,HIV,Biology and Life Sciences,Immunology,Vaccination and Immunization,Antiviral Therapy,Antiretroviral Therapy,Medicine and Health Sciences,Immunology,Vaccination and Immunization,Antiviral Therapy,Antiretroviral Therapy,Medicine and Health Sciences,Public and Occupational Health,Preventive Medicine,Vaccination and Immunization,Antiviral Therapy,Antiretroviral Therapy,People and Places,Geographical Locations,Africa,Zambia,Medicine and Health Sciences,Infectious Diseases,Bacterial Diseases,Tuberculosis,Medicine and Health Sciences,Tropical Diseases,Tuberculosis,People and Places,Population Groupings,Age Groups,Adults,Medicine and health sciences,Diagnostic medicine,HIV diagnosis and management,People and Places,Geographical Locations,Africa,