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Home >> Publications >> The impact of gender and income on survival and retention in a South African antiretroviral therapy programme.

Publication

Author(s):

Cornell M, Myer L, Kaplan R, Bekker LG, Wood R.

Pub Title:

The impact of gender and income on survival and retention in a South African antiretroviral therapy programme.

Pub Date:

Jul 31 2009

Pub Region(s):

Southern Africa

Journal Issue:

7

Page Number:
722-31

Journal:

Title: 
Tropical Medicine and International Health
Link: 
http://onlinelibrary.wiley.com/doi/10.1111/j.1365-3156.2009.02290.x/abstract

PubMed: 19413745
Pub PDF: PDF icon 19413745.pdf

Abstract
OBJECTIVES
: Despite the rapid expansion of antiretroviral therapy (ART) services in Africa, there are few data on whether outcomes differ for women and men and what factors may drive such variation. We investigated the association of gender and income with survival and retention in a South African ART programme.

METHODS: A total of 2196 treatment-naïve adults were followed for 1 year on ART. Proportional hazards regression was used to explore associations between baseline characteristics and survival and loss-to-follow-up (LTFU).

RESULTS: Patients were predominantly female (67%). Men presented at an older age and with more advanced HIV disease, and during early ART the crude death rate was higher among men than women (22.8 vs 12.5/100 person-years; P = 0.002). However in multivariate analysis, gender was not significantly associated with survival after adjusting for baseline clinical and immunovirological status (HR = 1.46, 95% CI = 0.96-2.22; P = 0.076). In late ART (4-12 months), there was no gender difference in mortality rates (3.5 vs 3.8/100 person-years; P = 0.817). In multivariate analysis, survival was strongly associated with age (HR = 1.05, 95% CI = 1.02-1.09; P < 0.001), CD4 count >150 vs <50 cells/microl (HR = 0.35, 95% CI = 0.14-0.87; P = 0.023) and any monthly income vs none (HR = 0.47, 95% CI = 0.25-0.88; P = 0.018). Having some monthly income was protective against LTFU at 1 year on ART (adjusted HR = 0.56, 95% CI = 0.39-0.82; P = 0.002).

CONCLUSION: Men's high early mortality on ART appears due largely to their presentation with more advanced HIV disease. Efforts are needed to enroll men into care earlier in HIV disease and to reduce socio-economic inequalities in ART programme outcomes.

PMID: 19413745 [PubMed - indexed for MEDLINE]

PMCID: PMC2771267

 

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Citation:

Cornell M, Myer L, Kaplan R, Bekker LG, Wood R. The impact of gender and income on survival and retention in a South African antiretroviral therapy programme. Trop Med Int Health. 2009 Jul;14(7):722-31. doi: 10.1111/j.1365-3156.2009.02290.x. Epub 2009 Apr 27. PubMed PMID: 19413745; PubMed Central PMCID: PMC2771267.