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Home >> Publications >> Monitoring of antiretroviral therapy and mortality in HIV programmes in Malawi, South Africa and Zambia: mathematical modelling study.

Publication

Author(s):

Estill J, Egger M, Johnson LF, Gsponer T, Wandeler G, Davies MA, Boulle A, Wood R, Garone D, Stringer JS, Hallett TB, Keiser O; IeDEA Southern Africa Collaboration.

Pub Title:

Monitoring of antiretroviral therapy and mortality in HIV programmes in Malawi, South Africa and Zambia: mathematical modelling study.

Pub Date:

Feb 28 2013

Pub Region(s):

Southern Africa

Journal Issue:

2

Page Number:
e57611

Journal:

Title: 
PLoS One
Link: 
http://www.plosone.org/article/info%3Adoi%2F10.1371%2Fjournal.pone.0057611

PubMed: 23469035
Pub PDF: PDF icon 23469035.pdf

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.

PMID: 23469035 [PubMed - indexed for MEDLINE]

PMCID: PMC3585414

 

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Citation:

Estill J, Egger M, Johnson LF, Gsponer T, Wandeler G, Davies MA, Boulle A, Wood R, Garone D, Stringer JS, Hallett TB, Keiser O; IeDEA Southern Africa Collaboration. Monitoring of antiretroviral therapy and mortality in HIV programmes in Malawi, South Africa and Zambia: mathematical modelling study. PLoS One. 2013;8(2):e57611. doi: 10.1371/journal.pone.0057611. Epub 2013 Feb 28. PubMed PMID: 23469035; PubMed Central PMCID: PMC3585414.