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Evaluation of 9 Years of National Antiretroviral Treatment in Botswana

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).

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Evaluation of 9 Years of National Antiretroviral Treatment in Botswana

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  1. Richard Marlink, MD Mansour Farahani MD,MPH, ScD Evaluation of 9 Years of National Antiretroviral Treatment in Botswana

  2. Data management Total number of adult patients in dataset (n=142,611) (1,894,396 observations) • 1,144 patients removed for having an observation after the recorded death • 924 patients removed without information for medication, death or CD4 • 295 patients removed because of inconsistency in the data • 14,272 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)

  3. Summary stat. • Sample size (adult) 125,976 • Median follow-up visits 11 (IQR, 6 to 21) • Died in the 1styear of treatment 3,349 • Public-Private Partnership 6,484(5%) • Overall Death 10,230 (8.1%) • Female 62.5%

  4. Study Population

  5. Summary stat.

  6. Summary stat. • Total follow-up time 281067.34 P-Y • Total number of death (on treatment) 7257 • Overall mortality rate 25.8 (1000 P-Y)

  7. Mortality rate (1000 P-Y) in Masa program

  8. Mortality rate in the first year in Masa Program

  9. Findings summary • Overall mortality has dropped over the life of the program • Higher mortality in the first 6 months • Program sees to improve over time • No significant advantage for TDF over ZDV or EFV over NVP

  10. Disparity in the MASA Project

  11. MASA Data by District

  12. Population Demographics • About 60% of the patients were female across all districts • The mean age at treatment initiation was between 36 and 38

  13. Proportion of Deaths by number of Patients in District

  14. Proportion of LTFUs by number of Patients in District

  15. Duration of treatment follow-up

  16. Changes in CD4 over time, by District

  17. Survival Model

  18. Graphic life tables

  19. Graphic life tables

  20. Adjusted* 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 .

  21. Findings summary • Wide 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.

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