TY - JOUR
T1 - The effect of antiretroviral therapy guideline change on health outcomes among youth living with HIV in Uganda
AU - Nakalema, Hilda Sekabira
AU - Rajan, Suja S.
AU - Morgan, Robert O.
AU - Lee, Minjae
AU - Gillespie, Susan L.
AU - Kekitiinwa, Adeodata
N1 - Publisher Copyright:
© 2020 Informa UK Limited, trading as Taylor & Francis Group.
PY - 2021
Y1 - 2021
N2 - Opportunistic infections (OIs) are the primary cause of HIV-related morbidity and mortality. To reduce the risk, the ART eligibility criteria were revised to start treatment before advanced disease onset. We evaluated the effect of 2014 HIV clinical guideline changes in Uganda on opportunistic infections and survival among Youth Living with HIV (YLWH). This retrospective cohort analysis used administrative data from the District Health Information System (DHIS2) and the national referral hospital, to compare YLWH, 15–24 years old, who started ART pre-guideline (January 2012–June 2014) and post-guideline (July 2014–December 2016). We assessed the effect using multivariable logistic and Cox Proportional Hazards regression models, respectively. Post-guideline youth had 18% and 30% lower adjusted odds of having an OI at 6 (aOR: 0.82, 95%CI: 0.67, 0.99), and 12 months (aOR: 0.70, 95%CI: 0.58, 0.85) after ART initiation, compared to pre-guideline youth. No significant differences were observed in survival probabilities (Z = 2.56, P-value = 0.11) and adjusted hazard ratios (aHR: 1.55, 95%CI: 0.46, 5.28). Early ART initiation reduced the risk of OIs among YLWH. However, given the existence of geographical and clinical variations in the endemicity, morbidity and mortality associated with different OIs, additional research is still needed.
AB - Opportunistic infections (OIs) are the primary cause of HIV-related morbidity and mortality. To reduce the risk, the ART eligibility criteria were revised to start treatment before advanced disease onset. We evaluated the effect of 2014 HIV clinical guideline changes in Uganda on opportunistic infections and survival among Youth Living with HIV (YLWH). This retrospective cohort analysis used administrative data from the District Health Information System (DHIS2) and the national referral hospital, to compare YLWH, 15–24 years old, who started ART pre-guideline (January 2012–June 2014) and post-guideline (July 2014–December 2016). We assessed the effect using multivariable logistic and Cox Proportional Hazards regression models, respectively. Post-guideline youth had 18% and 30% lower adjusted odds of having an OI at 6 (aOR: 0.82, 95%CI: 0.67, 0.99), and 12 months (aOR: 0.70, 95%CI: 0.58, 0.85) after ART initiation, compared to pre-guideline youth. No significant differences were observed in survival probabilities (Z = 2.56, P-value = 0.11) and adjusted hazard ratios (aHR: 1.55, 95%CI: 0.46, 5.28). Early ART initiation reduced the risk of OIs among YLWH. However, given the existence of geographical and clinical variations in the endemicity, morbidity and mortality associated with different OIs, additional research is still needed.
KW - HIV
KW - Uganda
KW - antiretroviral therapy
KW - opportunistic infections
KW - survival
KW - youth
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U2 - 10.1080/09540121.2020.1829533
DO - 10.1080/09540121.2020.1829533
M3 - Article
C2 - 33021095
AN - SCOPUS:85092242804
SN - 0954-0121
VL - 33
SP - 904
EP - 913
JO - AIDS Care - Psychological and Socio-Medical Aspects of AIDS/HIV
JF - AIDS Care - Psychological and Socio-Medical Aspects of AIDS/HIV
IS - 7
ER -