Monitoring of antiretroviral therapy and mortality in HIV programmes in Malawi, South Africa and Zambia: mathematical modelling study.
<h4>Objectives</h4>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...
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Public Library of Science (PLoS)
2013-01-01
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| Series: | PLoS ONE |
| Online Access: | https://journals.plos.org/plosone/article/file?id=10.1371/journal.pone.0057611&type=printable |
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| author | 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 IeDEA Southern Africa Collaboration |
| author_facet | 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 IeDEA Southern Africa Collaboration |
| author_sort | Janne Estill |
| collection | DOAJ |
| description | <h4>Objectives</h4>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.<h4>Design</h4>Mathematical modelling study based on data from ART programmes.<h4>Methods</h4>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.<h4>Results</h4>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.<h4>Conclusions</h4>VL monitoring reduces mortality moderately when assuming improved adherence and decreased failure rates. |
| format | Article |
| id | doaj-art-b20bd305fc4444f3be3e4ddf86afbb68 |
| institution | OA Journals |
| issn | 1932-6203 |
| language | English |
| publishDate | 2013-01-01 |
| publisher | Public Library of Science (PLoS) |
| record_format | Article |
| series | PLoS ONE |
| spelling | doaj-art-b20bd305fc4444f3be3e4ddf86afbb682025-08-20T02:30:38ZengPublic Library of Science (PLoS)PLoS ONE1932-62032013-01-0182e5761110.1371/journal.pone.0057611Monitoring of antiretroviral therapy and mortality in HIV programmes in Malawi, South Africa and Zambia: mathematical modelling study.Janne EstillMatthias EggerLeigh F JohnsonThomas GsponerGilles WandelerMary-Ann DaviesAndrew BoulleRobin WoodDaniela GaroneJeffrey S A StringerTimothy B HallettOlivia KeiserIeDEA Southern Africa Collaboration<h4>Objectives</h4>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.<h4>Design</h4>Mathematical modelling study based on data from ART programmes.<h4>Methods</h4>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.<h4>Results</h4>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.<h4>Conclusions</h4>VL monitoring reduces mortality moderately when assuming improved adherence and decreased failure rates.https://journals.plos.org/plosone/article/file?id=10.1371/journal.pone.0057611&type=printable |
| spellingShingle | 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 IeDEA Southern Africa Collaboration Monitoring of antiretroviral therapy and mortality in HIV programmes in Malawi, South Africa and Zambia: mathematical modelling study. PLoS ONE |
| title | Monitoring of antiretroviral therapy and mortality in HIV programmes in Malawi, South Africa and Zambia: mathematical modelling study. |
| title_full | Monitoring of antiretroviral therapy and mortality in HIV programmes in Malawi, South Africa and Zambia: mathematical modelling study. |
| title_fullStr | Monitoring of antiretroviral therapy and mortality in HIV programmes in Malawi, South Africa and Zambia: mathematical modelling study. |
| title_full_unstemmed | Monitoring of antiretroviral therapy and mortality in HIV programmes in Malawi, South Africa and Zambia: mathematical modelling study. |
| title_short | Monitoring of antiretroviral therapy and mortality in HIV programmes in Malawi, South Africa and Zambia: mathematical modelling study. |
| title_sort | monitoring of antiretroviral therapy and mortality in hiv programmes in malawi south africa and zambia mathematical modelling study |
| url | https://journals.plos.org/plosone/article/file?id=10.1371/journal.pone.0057611&type=printable |
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