IDEAS home Printed from https://ideas.repec.org/a/plo/pone00/0057611.html
   My bibliography  Save this article

Monitoring of Antiretroviral Therapy and Mortality in HIV Programmes in Malawi, South Africa and Zambia: Mathematical Modelling Study

Author

Listed:
  • Janne Estill
  • Matthias Egger
  • Leigh F Johnson
  • Thomas Gsponer
  • Gilles Wandeler
  • Mary-Ann Davies
  • Andrew Boulle
  • Robin Wood
  • Daniela Garone
  • Jeffrey S A Stringer
  • Timothy B Hallett
  • Olivia Keiser
  • for the IeDEA Southern Africa Collaboration

Abstract

Objectives: Mortality in patients starting antiretroviral therapy (ART) is higher in Malawi and Zambia than in South Africa. We examined whether different monitoring of ART (viral load [VL] in South Africa and CD4 count in Malawi and Zambia) could explain this mortality difference. Design:: Mathematical modelling study based on data from ART programmes. Methods: We used a stochastic simulation model to study the effect of VL monitoring on mortality over 5 years. In baseline scenario A all parameters were identical between strategies except for more timely and complete detection of treatment failure with VL monitoring. Additional scenarios introduced delays in switching to second-line ART (scenario B) or higher virologic failure rates (due to worse adherence) when monitoring was based on CD4 counts only (scenario C). Results are presented as relative risks (RR) with 95% prediction intervals and percent of observed mortality difference explained. Results: RRs comparing VL with CD4 cell count monitoring were 0.94 (0.74–1.03) in scenario A, 0.94 (0.77–1.02) with delayed switching (scenario B) and 0.80 (0.44–1.07) when assuming a 3-times higher rate of failure (scenario C). The observed mortality at 3 years was 10.9% in Malawi and Zambia and 8.6% in South Africa (absolute difference 2.3%). The percentage of the mortality difference explained by VL monitoring ranged from 4% (scenario A) to 32% (scenarios B and C combined, assuming a 3-times higher failure rate). Eleven percent was explained by non-HIV related mortality. Conclusions: VL monitoring reduces mortality moderately when assuming improved adherence and decreased failure rates.

Suggested Citation

  • Janne Estill & Matthias Egger & Leigh F Johnson & Thomas Gsponer & Gilles Wandeler & Mary-Ann Davies & Andrew Boulle & Robin Wood & Daniela Garone & Jeffrey S A Stringer & Timothy B Hallett & Olivia K, 2013. "Monitoring of Antiretroviral Therapy and Mortality in HIV Programmes in Malawi, South Africa and Zambia: Mathematical Modelling Study," PLOS ONE, Public Library of Science, vol. 8(2), pages 1-8, February.
    • Handle: RePEc:plo:pone00:0057611
    DOI: 10.1371/journal.pone.0057611
    as

    Download full text from publisher

    File URL: https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0057611
    Download Restriction: no
    File URL: https://journals.plos.org/plosone/article/file?id=10.1371/journal.pone.0057611&type=printable
    Download Restriction: no
    File URL: https://libkey.io/10.1371/journal.pone.0057611?utm_source=ideas
    LibKey link: if access is restricted and if your library uses this service, LibKey will redirect you to where you can use your library subscription to access this item
    ---><---

    References listed on IDEAS

    as
    1. Martin W G Brinkhof & Mar Pujades-Rodriguez & Matthias Egger, 2009. "Mortality of Patients Lost to Follow-Up in Antiretroviral Treatment Programmes in Resource-Limited Settings: Systematic Review and Meta-Analysis," PLOS ONE, Public Library of Science, vol. 4(6), pages 1-9, June.
    Full references (including those not matched with items on IDEAS)

    Citations

    Citations are extracted by the CitEc Project, subscribe to its RSS feed for this item.
    as


    Cited by:

    1. Andrew Phillips & Valentina Cambiano & Fumiyo Nakagawa & Travor Magubu & Alec Miners & Debbie Ford & Deenan Pillay & Andrea De Luca & Jens Lundgren & Paul Revill, 2014. "Cost-Effectiveness of HIV Drug Resistance Testing to Inform Switching to Second Line Antiretroviral Therapy in Low Income Settings," PLOS ONE, Public Library of Science, vol. 9(10), pages 1-10, October.

    Most related items

    These are the items that most often cite the same works as this one and are cited by the same works as this one.
    1. Ingrid V Bassett & Darshini Govindasamy & Alison S Erlwanger & Emily P Hyle & Katharina Kranzer & Nienke van Schaik & Farzad Noubary & A David Paltiel & Robin Wood & Rochelle P Walensky & Elena Losina, 2014. "Mobile HIV Screening in Cape Town, South Africa: Clinical Impact, Cost and Cost-Effectiveness," PLOS ONE, Public Library of Science, vol. 9(1), pages 1-11, January.
    2. Julie Henriques & Mar Pujades-Rodriguez & Megan McGuire & Elisabeth Szumilin & Jean Iwaz & Jean-François Etard & René Ecochard, 2012. "Comparison of Methods to Correct Survival Estimates and Survival Regression Analysis on a Large HIV African Cohort," PLOS ONE, Public Library of Science, vol. 7(2), pages 1-7, February.
    3. James H McMahon & Julian H Elliott & Steven Y Hong & Silvia Bertagnolio & Michael R Jordan, 2013. "Effects of Physical Tracing on Estimates of Loss to Follow-Up, Mortality and Retention in Low and Middle Income Country Antiretroviral Therapy Programs: A Systematic Review," PLOS ONE, Public Library of Science, vol. 8(2), pages 1-12, February.
    4. April D. Kimmel & Daniel W. Fitzgerald & Jean W. Pape & Bruce R. Schackman, 2015. "Performance of a Mathematical Model to Forecast Lives Saved from HIV Treatment Expansion in Resource-Limited Settings," Medical Decision Making, , vol. 35(2), pages 230-242, February.
    5. Thomas N Nissen & Michala V Rose & Godfather Kimaro & Ib C Bygbjerg & Sayoki G Mfinanga & Pernille Ravn, 2012. "Challenges of Loss to Follow-up in Tuberculosis Research," PLOS ONE, Public Library of Science, vol. 7(7), pages 1-8, July.
    6. Hannock Tweya & Caryl Feldacker & Janne Estill & Andreas Jahn & Wingston Ng’ambi & Anne Ben-Smith & Olivia Keiser & Mphatso Bokosi & Matthias Egger & Colin Speight & Joe Gumulira & Sam Phiri, 2013. "Are They Really Lost? “True” Status and Reasons for Treatment Discontinuation among HIV Infected Patients on Antiretroviral Therapy Considered Lost to Follow Up in Urban Malawi," PLOS ONE, Public Library of Science, vol. 8(9), pages 1-1, September.
    7. Kara G Marson & Kenneth Tapia & Pamela Kohler & Christine J McGrath & Grace C John-Stewart & Barbra A Richardson & Julia W Njoroge & James N Kiarie & Samah R Sakr & Michael H Chung, 2013. "Male, Mobile, and Moneyed: Loss to Follow-Up vs. Transfer of Care in an Urban African Antiretroviral Treatment Clinic," PLOS ONE, Public Library of Science, vol. 8(10), pages 1-1, October.
    8. Faith Martin & Steve Russell & Janet Seeley, 2014. "Higher Quality of Life and Lower Depression for People on ART in Uganda as Compared to a Community Control Group," PLOS ONE, Public Library of Science, vol. 9(8), pages 1-8, August.
    9. Matthew R Lamb & Wafaa M El-Sadr & Elvin Geng & Denis Nash, 2012. "Association of Adherence Support and Outreach Services with Total Attrition, Loss to Follow-Up, and Death among ART Patients in Sub-Saharan Africa," PLOS ONE, Public Library of Science, vol. 7(6), pages 1-12, June.
    10. Elizabeth R Stevens & Lingfeng Li & Kimberly A Nucifora & Qinlian Zhou & Margaret L McNairy & Averie Gachuhi & Matthew R Lamb & Harriet Nuwagaba-Biribonwoha & Ruben Sahabo & Velephi Okello & Wafaa M E, 2018. "Cost-effectiveness of a combination strategy to enhance the HIV care continuum in Swaziland: Link4Health," PLOS ONE, Public Library of Science, vol. 13(9), pages 1-17, September.
    11. Christian Unge & Björn Södergård & Gaetano Marrone & Anna Thorson & Abigael Lukhwaro & Jane Carter & Festus Ilako & Anna Mia Ekström, 2010. "Long-Term Adherence to Antiretroviral Treatment and Program Drop-Out in a High-Risk Urban Setting in Sub-Saharan Africa: A Prospective Cohort Study," PLOS ONE, Public Library of Science, vol. 5(10), pages 1-12, October.
    12. Heidi M Soeters & Charles Poole & Monita R Patel & Annelies Van Rie, 2013. "The Effect of Tuberculosis Treatment at Combination Antiretroviral Therapy Initiation on Subsequent Mortality: A Systematic Review and Meta-Analysis," PLOS ONE, Public Library of Science, vol. 8(10), pages 1-1, October.
    13. Martin W G Brinkhof & Ben D Spycher & Constantin Yiannoutsos & Ralf Weigel & Robin Wood & Eugène Messou & Andrew Boulle & Matthias Egger & Jonathan A C Sterne & for the International epidemiological D, 2010. "Adjusting Mortality for Loss to Follow-Up: Analysis of Five ART Programmes in Sub-Saharan Africa," PLOS ONE, Public Library of Science, vol. 5(11), pages 1-6, November.
    14. Anthony Harries & Simon Makombe & Erik Schouten & Andreas Jahn & Edwin Libamba & Kelita Kamoto & Frank Chimbwandira, 2012. "How operational research influenced the scale up of antiretroviral therapy in Malawi," Health Care Management Science, Springer, vol. 15(3), pages 197-205, September.

    More about this item

    Statistics

    Access and download statistics

    Corrections

    All material on this site has been provided by the respective publishers and authors. You can help correct errors and omissions. When requesting a correction, please mention this item's handle: RePEc:plo:pone00:0057611. See general information about how to correct material in RePEc.

    If you have authored this item and are not yet registered with RePEc, we encourage you to do it here. This allows to link your profile to this item. It also allows you to accept potential citations to this item that we are uncertain about.

    If CitEc recognized a bibliographic reference but did not link an item in RePEc to it, you can help with this form .

    If you know of missing items citing this one, you can help us creating those links by adding the relevant references in the same way as above, for each refering item. If you are a registered author of this item, you may also want to check the "citations" tab in your RePEc Author Service profile, as there may be some citations waiting for confirmation.

    For technical questions regarding this item, or to correct its authors, title, abstract, bibliographic or download information, contact: plosone (email available below). General contact details of provider: https://journals.plos.org/plosone/ .

    Please note that corrections may take a couple of weeks to filter through the various RePEc services.

    IDEAS is a RePEc service. RePEc uses bibliographic data supplied by the respective publishers.