Patients’ characteristics at ART initiation
The analysis included 23,890 patients, who initiated ART between January 1, 2004 and December 31, 2012 and completed 36 months of follow-up by March 30, 2015. The majority, 16,182 (67.7%), were female and slightly less than half 10,827 (45.3%), were between ages 20 to 35 years. About 47.0% (11,143) were married. Median age at ART initiation was 38 years (IQR: 37 – 44), 80.6% had CD4 cell counts less than 250 cells/ and only 0.7% had CD4 cell counts greater than 500 cells/µL. Forty-five percent of patients had WHO clinical stage III and IV disease and 26.9% had a BMI below 18.5 kg/m². More than half (54.2%) were initiated on a D4T-based ART regimen.
Temporal changes in patient baseline characteristics and outcomes
The number of patients initiating ART increased each calendar year from 368 in 2004 to 2,968 in 2012. Median baseline CD4 count increased in the period from 96 cells cells/ (IQR: 38 – 170) in 2004 to 197 cells cells/µL (IQR: 85 – 286) in 2012. The proportion of patients with WHO clinical stage III and IV disease decreased from 30.5% (101) in 2004 to 2.9% (76) in 2012.
After 36 months of follow up, a total of 3,222 patients (13.5%) had died, 556 (2.3%) within first six months and 1,027 (4.3%) between 25-36 months on ART. With regard to LTFU, 2,451 (10.3%) of patients were LTFU at 6 months and 6,499 (27.2%) between 25 and 36 months. The descriptive information of study participants in the cohort, including mortality and LTFU outcomes at 6, 12, 24, and 36 months of ART are presented in Table 1. The overall retention was 87.4% at 6 months and 68.5% at 36 months of follow up.
Factors associated with mortality in multivariate analysis
Mortality was associated with male gender (6 month aOR, 1.66, 95% CI 1.38–2.00, p <0.001 and 36 month aOR, 1.59, 95% CI 1.39–1.83, p <0.001), older age 51 years and above using 20-35 years as reference (6 month aOR, 1.34, 95% CI 1.00–1.78, p = 0.047 and 36 month aOR, 1.51, 95% CI 1.23–1.86, p <0.001), and, being single (6 month aOR, 1.30, 95% CI 1.00–1.68, p =0.050 and 36 month aOR, 1.36, 95% CI 1.13–1.63, p = 0.001) or divorced (6 month aOR, 1.99, 95% CI 1.58–2.51, p <0.001 and 36 month aOR, 1.86, 95% CI 1.56–2.22, p <0.001) using married as reference. Mortality was also associated with advanced WHO clinical stage III, using stage I as the reference, (6 month aOR, 2.27, 95% CI 1.49–3.47, p <0.001 and 36 month aOR, 1.94, 95% CI 1.43–2.63, p <0.001) and clinical stage IV (6 month aOR, 5.29, 95% CI 3.45–8.10, p <0.001 and 36 month aOR, 4.24, 95% CI 3.06–5.87, p <0.001), and low BMI of less than 18.5 kg/m² using 18.5-24.9 kg/m² as reference (6 month aOR, 1.65, 95% CI 1.32–2.06, p <0.001 and 36 month aOR, 1.54, 95% CI 1.31–1.82, p <0.001). Patients initiated on a TDF-based ART regimen had lower odds of mortality using a D4T-based regimen as reference (6 month aOR, 0.58, 95% CI 0.46–0.74, p <0.001 and 36 month aOR, 0.55, 95% CI 0.46–0.65, p <0.001). Among those initiated on an AZT-based ART regime, mortality risk was lower later in treatment using D4T-based regimen as reference (36 month aOR 0.83, 95% CI 0.70-0.99, p = 0.040). Univariate and multivariate analysis of these factors are presented in Tables 2 and 3 respectively.
Factors associated with LTFU in multivariate analysis
LTFU was associated with male gender (6 month aOR, 1.23, 95% CI 1.12–1.36, p <0.001 and 36 month aOR, 1.19, 95% CI 1.12–1.27, p <0.001), younger age, 20 to 35 years using 36-50 years as reference (6 month aOR, 1.23, 95% CI 1.12–1.35, p <0.001 and 36 month aOR, 1.49, 95% CI 1.40–1.59, p <0.001) being single (6 month aOR, 1.34, 95% CI 1.19–1.51, p <0.001 and 36 month aOR, 1.34, 95% CI 1.23–1.45, p <0.001) and being divorced (6 month aOR, 1.35, 95% CI 1.19–1.53, p <0.001 and 36 month aOR, 1.25, 95% CI 1.15–1.36, p <0.001) using married as reference. Risk of LTFU was also higher, using WHO clinical stage I as the reference group, among those with advanced WHO clinical stage III (6 month aOR, 1.34, 95% CI 1.14–1.57, p <0.001 and 36 month aOR, 1.22, 95% CI 1.12–1.34, p <0.001) and stage IV (6 month aOR, 1.83, 95% CI 1.48–2.26, p <0.001 and 36 month aOR, 1.34, 95% CI 1.15–1.57, p <0.001), lower CD4 counts (6 month aOR, 1.34, 95% CI 1.16–1.55, p <0.001 and 36 month aOR, 1.18, 95% CI 1.08–1.29, p <0.001 for CD4 counts <=250 cells/µl) and low BMI <18.5 kg/m² compared to normal BMI (6 month aOR, 1.37, 95% CI 1.21–1.56, p <0.001 and 36 month aOR, 1.16, 95% CI 1.06–1.27, p <0.001). Patients on an ABC-based ART regimen were also significantly more likely to be LTFU using D4T-based regimen as reference (6 month aOR, 2.37, 95% CI 1.82–3.08, p <0.001 and 36 month aOR, 2.17, 95% CI 1.75–2.69, p <0.001). Univariate and multivariate regression analysis of these factors are presented in Tables 4 and 5 respectively.
Table 1 Descriptive characteristics of HIV-infected adults on antiretroviral therapy by mortality and LTFU outcomes
|
Mortality
|
|
|
|
LTFU
|
|
|
|
|
6 months
|
12 months
|
24 months
|
36 months
|
6 months
|
12 months
|
24 months
|
36 months
|
|
n (%)
|
n (%)
|
n (%)
|
n (%)
|
n (%)
|
n (%)
|
n (%)
|
n (%)
|
Gender
|
|
|
|
|
|
|
|
|
Female (n=16182)
|
304 (54.7)
|
395 (55.2)
|
519 (56.2)
|
576 (56.1)
|
1549 (63.2)
|
2272 (64.7)
|
3358 (65.6)
|
4282 (65.9)
|
Male (n=7708)
|
252 (45.3)
|
320 (44.8)
|
405 (43.8)
|
451 (43.9)
|
902 (36.8)
|
1241 (35.3)
|
1759 (34.4)
|
2217 (34.1)
|
Total (n=23890)
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Age
|
|
|
|
|
|
|
|
|
20-35 (n=10827)
|
229 (41.2)
|
281 (39.3)
|
370 (40.0)
|
414 (40.3)
|
1203 (49.1)
|
1797 (51.2)
|
2675 (52.3)
|
3369 (51.8)
|
36-50 (n=10629)
|
255 (45.9)
|
336 (47.0)
|
425 (46.0)
|
470 (45.8)
|
1016 (41.5)
|
1404 (40.0)
|
2001 (39.1)
|
2558 (39.4)
|
51+ (n=2434)
|
72 (12.9)
|
98 (13.7)
|
129 (14.0)
|
143 (13.9)
|
232 (9.5)
|
312 (8.9)
|
441 (8.6)
|
572 (8.8)
|
Total (n=23890)
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Marital Status
|
|
|
|
|
|
|
|
|
Divorced (n=3923)
|
91 (17.7)
|
126 (19.0)
|
165 (19.1)
|
178 (18.8)
|
451 (21.0)
|
644 (20.6)
|
906 (19.7)
|
1193 (20.3)
|
Married (n=11143)
|
203 (39.6)
|
273 (41.1)
|
353 (41.0)
|
385 (40.7)
|
963 (44.7)
|
1422 (45.5)
|
2128 (46.4)
|
2738 (46.7)
|
Single (n=4091)
|
146 (28.5)
|
179 (27.0)
|
224 (26.0)
|
251 (26.5)
|
487 (22.6)
|
699 (22.4)
|
1014 (22.1)
|
1235 (21.1)
|
Widowed (n=2975)
|
73 (14.2)
|
86 (13.0)
|
120 (13.9)
|
133 (14.0)
|
251 (11.7)
|
359 (11.5)
|
541 (11.8)
|
698 (11.9)
|
Total (n=22132)
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
BMI
|
|
|
|
|
|
|
|
|
<18.5 (n=3466)
|
123 (49.2)
|
148 (47.6)
|
191 (46.8)
|
210 (47.1)
|
326 (40.3)
|
441 (36.7)
|
633 (33.0)
|
819 (30.9)
|
18.5-24.9 (n=6887)
|
110 (44.0)
|
137 (44.1)
|
181 (44.4)
|
197 (44.2)
|
399 (49.4)
|
623 (51.9)
|
1027 (53.6)
|
1437 (54.3)
|
25-29.9 (n=1708)
|
13 (5.2)
|
19 (6.1)
|
26 (6.4)
|
29 (6.5)
|
59 (7.3)
|
96 (8)
|
178 (9.3)
|
264 (10.0)
|
30+ (n=807)
|
4 (1.6)
|
7 (2.3)
|
10 (2.5)
|
10 (2.2)
|
24 (3.0)
|
41 (3.4)
|
79 (4.1)
|
128 (4.8)
|
Total (n=12868)
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Baseline CD4
|
|
|
|
|
|
|
|
0-250 (n=15483)
|
387 (91.7)
|
491 (90.9)
|
648 (91.7)
|
715 (90.9)
|
1615 (86.5)
|
2343 (85.9)
|
3357 (83.5)
|
4275 (83.1)
|
251-500 (n=3611)
|
34 (8.1)
|
48 (8.9)
|
56 (7.9)
|
69 (8.8)
|
236 (12.6)
|
366 (13.4)
|
630 (15.7)
|
830 (16.1)
|
Above 500 (n=124)
|
1 (0.2)
|
1 (0.2)
|
3 (0.4)
|
3 (0.4)
|
15 (0.8)
|
19 (0.7)
|
33 (0.8)
|
39 (0.8)
|
Total (n=19218)
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Regimen started
|
|
|
|
|
|
|
|
|
ABC-based (n=370)
|
8 (1.4)
|
8 (1.1)
|
9 (1.0)
|
9 (0.9)
|
82 (3.3)
|
113 (3.2)
|
148 (2.9)
|
166 (2.6)
|
AZT-based (n=4465)
|
102 (18.3)
|
130 (18.2)
|
156 (16.9)
|
167 (16.3)
|
371 (15.1)
|
544 (15.5)
|
827 (16.2)
|
1102 (17.0)
|
D4T-based (n=12949)
|
360 (64.7)
|
466 (65.2)
|
613 (66.3)
|
690 (67.2)
|
1556 (63.5)
|
2178 (62.0)
|
3062 (59.8)
|
3728 (57.4)
|
TDF-based (n=6106)
|
86 (15.5)
|
111 (15.5)
|
146 (15.8)
|
161 (15.7)
|
442 (18.0)
|
678 (19.3)
|
1080 (21.1)
|
1503 (23.1)
|
Total (n=23890)
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
WHO clinical stage at ART initiation
|
|
|
|
|
|
|
|
|
Stage I (n=3310)
|
30 (6.4)
|
40 (6.7)
|
53 (6.9)
|
63 (7.5)
|
231 (13.5)
|
354 (14.2)
|
572 (15.5)
|
763 (16.1)
|
Stage II (n=6800)
|
104 (22.3)
|
136 (22.6)
|
183 (23.8)
|
208 (24.7)
|
535 (31.4)
|
832 (33.4)
|
1267 (34.3)
|
1661 (34.9)
|
Stage III (n=7282)
|
249 (53.3)
|
322 (53.6)
|
404 (52.5)
|
436 (51.8)
|
801 (47.0)
|
1132 (45.5)
|
1632 (44.1)
|
2047 (43.1)
|
Stage IV (n=994)
|
84 (18.0)
|
103 (17.1)
|
129 (16.8)
|
135 (16.0)
|
138 (8.1)
|
171 (6.9)
|
226 (6.1)
|
282 (5.9)
|
Total (n=18386)
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Dead
|
556 (2.3)
|
715 (3.0)
|
924 (3.9)
|
1027 (4.3)
|
|
|
|
LTFU
|
|
|
|
|
2451 (10.3)
|
3513 (14.7)
|
5117 (21.4)
|
6499 (27.2)
|
|
|
|
|
|
|
|
|
|
Mortality Results
Univariate analysis
Table 2 Univariate analysis of factors associated with mortality among HIV-infected adults on antiretroviral therapy
|
Univariable Results (n=23890)
|
|
|
|
|
|
|
6 months
|
|
12 months
|
|
24 months
|
|
36 months
|
|
|
OR (95% CI)
|
P value
|
OR (95% CI)
|
P value
|
OR (95% CI)
|
P value
|
OR (95% CI)
|
P value
|
Gender
|
|
|
|
|
|
|
|
|
Male
|
1.77 (1.49-2.09)
|
<0.001
|
1.73 (1.49-2.01)
|
<0.001
|
1.67 (1.47-1.91)
|
<0.001
|
1.68 (1.48-1.91)
|
<0.001
|
Female
|
Ref
|
|
Ref
|
|
Ref
|
|
Ref
|
|
Age groups
|
|
|
|
|
|
|
|
|
20-35
|
Ref
|
|
Ref
|
|
Ref
|
|
Ref
|
|
36-50
|
1.14 (0.95-1.36)
|
0.162
|
1.23 (1.04-1.44)
|
0.013
|
1.18 (1.02-1.36)
|
0.024
|
1.16 (1.02-1.33)
|
0.028
|
51+
|
1.41 (1.08-1.85)
|
0.012
|
1.57 (1.25-1.99)
|
<0.001
|
1.58 (1.29-1.94)
|
<0.001
|
1.57 (1.29-1.91)
|
<0.001
|
Marital Status
|
|
|
|
|
|
|
|
|
Single
|
1.3 (1.01-1.68)
|
0.043
|
1.35 (1.08-1.68)
|
0.008
|
1.36 (1.13-1.64)
|
0.002
|
1.34 (1.12-1.6)
|
<0.001
|
Divorced
|
1.96 (1.58-2.43)
|
<0.001
|
1.80 (1.49-2.18)
|
<0.001
|
1.76 (1.49-2.08)
|
<0.001
|
1.79 (1.53-2.11)
|
<0.001
|
Married
|
Ref
|
|
Ref
|
|
Ref
|
|
Ref
|
|
Widowed
|
1.34 (1.01-1.77)
|
0.043
|
1.19 (0.92-1.53)
|
0.186
|
1.29 (1.04-1.60)
|
0.023
|
1.3 (1.05-1.61)
|
0.014
|
BMI
|
|
|
|
|
|
|
|
|
<18.5
|
1.96 (1.56-2.47)
|
<0.001
|
1.85 (1.52-2.26)
|
<0.001
|
1.82 (1.53-2.17)
|
<0.001
|
1.79 (1.52-2.11)
|
<0.001
|
18.5-24.9
|
Ref
|
|
Ref
|
|
Ref
|
|
Ref
|
|
25-29.9
|
0.50 (0.32-0.78)
|
0.002
|
0.54 (0.36-0.81)
|
0.003
|
0.57 (0.41-0.8)
|
0.001
|
1.10 (0.63-1.94)
|
0.001
|
30+
|
0.37 (0.17-0.81)
|
0.013
|
0.45 (0.24-0.85)
|
0.013
|
0.53 (0.31-0.91)
|
0.02
|
0.54 (0.34-0.88)
|
0.013
|
CD4
|
|
|
|
|
|
|
|
|
0-250
|
2.35 (0.39-14.22)
|
0.354
|
2.23 (0.45-11.11)
|
0.329
|
1.42 (0.48-4.23)
|
0.528
|
1.52 (0.51-4.49)
|
0.453
|
251-500
|
0.91 (0.14-5.83)
|
0.923
|
0.94 (0.18-4.77)
|
0.938
|
0.57 (0.18-1.74)
|
0.320
|
0.66 (0.22-2.00)
|
0.460
|
Above 500
|
Ref
|
|
Ref
|
|
Ref
|
|
Ref
|
|
Regimen Started
|
|
|
|
|
|
|
|
|
D4T-based
|
Ref
|
|
Ref
|
|
Ref
|
|
Ref
|
|
ABC-based
|
0.77 (0.38-1.57)
|
0.476
|
0.59 (0.29-1.2)
|
0.146
|
0.50 (0.26-0.98)
|
0.042
|
0.44 (0.23-0.86)
|
0.016
|
AZT-based
|
0.82 (0.65-1.02)
|
0.076
|
0.80 (0.66-0.98)
|
0.147
|
0.73 (0.61-0.87)
|
<0.001
|
0.69 (0.58-0.82)
|
<0.001
|
TDF-based
|
0.50 (0.39-0.63)
|
<0.001
|
0.50 (0.40-0.61)
|
0.148
|
0.49 (0.41-0.59)
|
<0.001
|
0.48 (0.40-0.57)
|
<0.001
|
WHO Stage clinical stage at ART initiation
|
|
|
|
|
|
|
|
|
Stage I
|
Ref
|
|
Ref
|
|
Ref
|
|
Ref
|
|
Stage II
|
1.56 (1.03-2.37)
|
0.036
|
1.57 (1.07-2.30)
|
0.02
|
1.56 (1.11-2.18)
|
0.01
|
1.50 (1.09-2.06)
|
0.012
|
Stage III
|
3.37 (2.23-5.10)
|
<0.001
|
3.32 (2.29-4.82)
|
<0.001
|
3.10 (2.26-4.25)
|
<0.001
|
2.84 (2.11-3.83)
|
<0.001
|
Stage IV
|
8.18 (5.38-12.44)
|
<0.001
|
7.68 (5.27-11.20)
|
<0.001
|
7.25 (5.23-10.04)
|
<0.001
|
6.41 (4.68-8.78)
|
<0.001
|
|
|
|
|
|
|
|
|
|
Multivariate analysis
Table 3 Multivariate analysis of factors associated with mortality among HIV-infected adults on antiretroviral therapy
|
Multivariate Results (n=23890)
|
|
|
|
|
|
|
6 months
|
|
12 months
|
|
24 months
|
|
36 months
|
|
(n=23890)
|
aOR (95% CI)
|
P value
|
aOR (95% CI)
|
P value
|
aOR (95% CI)
|
P value
|
aOR (95% CI)
|
P value
|
Gender
|
|
|
|
|
|
|
|
Male
|
1.66 (1.38-2.00)
|
<0.001
|
1.59 (1.35-1.87)
|
<0.001
|
1.56 (1.35-1.80)
|
<0.001
|
1.59 (1.39-1.83)
|
<0.001
|
Female Ref
|
|
Ref
|
|
Ref
|
|
Ref
|
|
Age groups
|
|
|
|
|
|
|
|
|
20-35
|
Ref
|
|
Ref
|
|
Ref
|
|
Ref
|
|
36-50
|
1.06 (0.88-1.28)
|
0.545
|
1.15 (0.97-1.37)
|
0.098
|
1.10 (0.95-1.27)
|
0.223
|
1.09 (0.94-1.25)
|
0.248
|
51+
|
1.34 (1.00-1.78)
|
0.047
|
1.54 (1.2-1.98)
|
0.001
|
1.52 (1.22-1.90)
|
<0.001
|
1.51 (1.23-1.86)
|
<0.001
|
Marital Status
|
|
|
|
|
|
|
|
Single
|
1.30 (1.00-1.68)
|
0.05
|
1.34 (1.07-1.68)
|
0.01
|
1.36 (1.12-1.65)
|
0.002
|
1.36 (1.13-1.63)
|
0.001
|
Divorced
|
1.99 (1.58-2.51)
|
<0.001
|
1.86 (1.52-2.28)
|
<0.001
|
1.80 (1.50-2.15)
|
<0.001
|
1.86 (1.56-2.22)
|
<0.001
|
Married
|
Ref
|
|
Ref
|
|
Ref
|
|
Ref
|
|
Widowed
|
1.33 (0.99-1.78)
|
0.055
|
1.14 (0.88-1.49)
|
0.330
|
1.23 (0.98-1.55)
|
0.071
|
1.26 (1.01-1.58)
|
0.041
|
BMI
|
|
|
|
|
|
|
|
<18.5
|
1.65 (1.32-2.06)
|
<0.001
|
1.57 (1.29-1.91)
|
<0.001
|
1.55 (1.30-1.85)
|
<0.001
|
1.54 (1.31-1.82)
|
<0.001
|
18.5-24.9
|
Ref
|
|
Ref
|
|
Ref
|
|
Ref
|
|
25-29.9
|
0.58 (0.37-0.9)
|
0.015
|
0.62 (0.41-0.94)
|
0.023
|
0.65 (0.46-0.92)
|
0.014
|
0.68 (0.50-0.92)
|
0.013
|
30+
|
0.41 (0.18-0.9)
|
0.026
|
0.49 (0.26-0.92)
|
0.027
|
0.57 (0.34-0.98)
|
0.04
|
0.58 (0.36-0.94)
|
0.027
|
CD4
|
|
|
|
|
|
|
|
0-250
|
2.66 (0.46-15.43)
|
0.275
|
2.51 (0.53-12.00)
|
0.249
|
1.59 (0.56-4.53)
|
0.388
|
1.68 (0.59-4.77)
|
0.331
|
251-500
|
1.56 (0.26-9.47)
|
0.628
|
1.59 (0.33-7.76)
|
0.565
|
0.94 (0.32-2.78)
|
0.913
|
1.09 (0.37-3.18)
|
0.873
|
Above 500
|
Ref
|
|
Ref
|
|
Ref
|
|
Ref
|
|
Regimen Started
|
|
|
|
|
|
|
|
D4T-based
|
Ref
|
|
Ref
|
|
Ref
|
|
Ref
|
|
ABC-based
|
0.95 (0.46-1.95)
|
0.889
|
0.71 (0.35-1.45)
|
0.346
|
0.60 (0.31-1.18)
|
0.140
|
0.52 (0.26-1.02)
|
0.056
|
AZT-based
|
1.02 (0.81-1.28)
|
0.896
|
0.99 (0.80-1.21)
|
0.887
|
0.89 (0.74-1.07)
|
0.214
|
0.83 (0.70-0.99)
|
0.04
|
TDF-based
|
0.58 (0.46-0.74)
|
<0.001
|
0.57 (0.46-0.71)
|
<0.001
|
0.57 (0.47-0.69)
|
<0.001
|
0.55 (0.46-0.65)
|
<0.001
|
Baseline WHO Stage
|
|
|
|
|
|
|
|
Stage I
|
Ref
|
|
Ref
|
|
Ref
|
|
Ref
|
|
Stage II
|
1.31 (0.86-2.01)
|
0.214
|
1.32 (0.90-1.95)
|
0.156
|
1.3 (0.93-1.83)
|
0.130
|
1.25 (0.91-1.72)
|
0.167
|
Stage III
|
2.27 (1.49-3.47)
|
<0.001
|
2.29 (1.56-3.35)
|
<0.001
|
2.11 (1.53-2.91)
|
<0.001
|
1.94 (1.43-2.63)
|
<0.001
|
Stage IV
|
5.29 (3.45-8.1)
|
<0.001
|
5.10 (3.46-7.50)
|
<0.001
|
4.79 (3.44-6.67)
|
<0.001
|
4.24 (3.06-5.87)
|
<0.001
|
|
|
|
|
|
|
|
|
|
LTFU Results
Univariate analysis
Table 4 Univariate analysis of factors associated with LTFU among HIV-infected adults on antiretroviral therapy
|
Univariable Results (n=23890)
|
|
|
|
|
|
|
|
6 months
|
|
12 months
|
|
24 months
|
|
36 months
|
|
|
OR (95% CI)
|
P value
|
OR (95% CI)
|
P value
|
OR (95% CI)
|
P value
|
OR (95% CI)
|
P value
|
Gender
|
|
|
|
|
|
|
|
|
Male
|
1.25 (1.15-1.37)
|
<0.001
|
1.18 (1.09-1.27)
|
<0.001
|
1.13 (1.06-1.21)
|
<0.001
|
1.12 (1.06-1.19)
|
<0.001
|
Female
|
Ref
|
|
Ref
|
|
Ref
|
|
Ref
|
|
Age groups
|
|
|
|
|
|
|
|
|
20-35
|
1.18 (1.08-1.29)
|
<0.001
|
1.31 (1.21-1.41)
|
<0.001
|
1.42 (1.33-1.51)
|
<0.001
|
1.43 (1.34-1.51)
|
<0.001
|
36-50
|
Ref
|
|
Ref
|
|
Ref
|
|
Ref
|
|
51+
|
1.00 (0.86-1.16)
|
0.967
|
0.97 (0.85-1.10)
|
0.607
|
0.95 (0.85-1.07)
|
0.419
|
0.97 (0.87-1.08)
|
0.555
|
Marital Status
|
|
|
|
|
|
|
|
|
Single
|
1.38 (1.22-1.55)
|
<0.001
|
1.34 (1.21-1.48)
|
<0.001
|
1.27 (1.16-1.39)
|
<0.001
|
1.34 (1.24-1.45)
|
<0.001
|
Divorced
|
1.44 (1.29-1.62)
|
<0.001
|
1.41 (1.28-1.56)
|
<0.001
|
1.4 (1.28-1.52)
|
<0.001
|
1.33 (1.23-1.44)
|
<0.001
|
Married
|
Ref
|
|
Ref
|
|
Ref
|
|
Ref
|
|
Widowed
|
0.99 (0.85-1.14)
|
0.833
|
0.94 (0.83-1.06)
|
0.280
|
0.94 (0.85-1.04)
|
0.243
|
0.94 (0.85-1.04)
|
0.214
|
BMI
|
|
|
|
|
|
|
|
|
<18.5
|
1.65 (1.41-1.94)
|
<0.001
|
1.48 (1.31-1.67)
|
<0.001
|
1.33 (1.20-1.47)
|
<0.001
|
1.23 (1.13-1.34)
|
<0.001
|
18.5-24.9
|
Ref
|
|
Ref
|
|
Ref
|
|
Ref
|
|
25-29.9
|
0.54 (0.41-0.72
|
<0.001
|
0.58 (0.46-0.73)
|
<0.001
|
0.63 (0.53-0.76)
|
<0.001
|
0.66 (0.58-0.76)
|
<0.001
|
30+
|
0.49 (0.36 – 0.66)
|
<0.001
|
0.50 (0.41-0.69)
|
<0.001
|
0.61 (0.51-0.73)
|
<0.001
|
0.67 (0.57-0.8)
|
<0.001
|
CD4
|
|
|
|
|
|
|
|
|
0-250
|
1.70 (1.47-1.96)
|
<0.001
|
1.6 (1.42-1.80)
|
<0.001
|
1.34 (1.22-1.47)
|
<0.001
|
1.30 (1.20-1.41)
|
<0.001
|
251-500
|
Ref
|
|
Ref
|
|
Ref
|
|
Ref
|
|
Above 500
|
1.91 (1.09-3.32)
|
0.023
|
1.55 (0.94-2.55)
|
0.086
|
1.70 (1.13-2.56)
|
0.011
|
1.53 (1.05-2.25)
|
0.028
|
Regimen Started
|
|
|
|
|
|
|
|
|
D4T-based
|
Ref
|
|
Ref
|
|
Ref
|
|
Ref
|
|
ABC-based
|
2.09 (1.62-2.68)
|
<0.001
|
2.17 (1.74-2.73)
|
<0.001
|
2.15 (1.74-2.66)
|
<0.001
|
2.01 (1.63-2.48)
|
<0.001
|
AZT-based
|
0.66 (0.59-0.75)
|
<0.001
|
0.69 (0.62-0.76)
|
<0.001
|
0.73 (0.67-0.80)
|
<0.001
|
0.81 (0.75-0.88)
|
<0.001
|
TDF-based
|
0.57 (0.51-0.64)
|
<0.001
|
0.62 (0.56-0.68)
|
<0.001
|
0.69 (0.64-0.75)
|
<0.001
|
0.81 (0.75-0.87)
|
<0.001
|
Baseline WHO Stage
|
|
|
|
|
|
|
|
|
Stage I
|
Ref
|
|
Ref
|
|
Ref
|
|
Ref
|
|
Stage II
|
1.16 (0.99-1.37)
|
0.0707
|
1.19 (1.04-1.36)
|
0.01
|
1.13 (1.01-1.26)
|
0.032
|
1.11 (1.02-1.22)
|
0.0230
|
Stage III
|
1.76 (1.51-2.06)
|
<0.001
|
1.63 (1.44-1.84)
|
<0.001
|
1.46 (1.32-1.61)
|
<0.001
|
1.38 (1.26-1.50)
|
<0.001
|
Stage IV
|
2.45 (1.98-3.04)
|
<0.001
|
1.99 (1.66-2.39)
|
<0.001
|
1.63 (1.40-1.91)
|
<0.001
|
1.53 (1.31-1.78)
|
<0.001
|
|
|
|
|
|
|
|
|
|
Multivariate analysis
Table 5 Multivariate analysis of factors associated with LTFU among HIV-infected adults on antiretroviral therapy
|
Multivariate Results (n=23890)
|
|
|
|
|
|
|
|
6 months
|
|
12 months
|
|
24 months
|
|
36 months
|
|
|
aOR (95% CI)
|
P value
|
aOR (95% CI)
|
P value
|
aOR (95% CI)
|
P value
|
aOR (95% CI)
|
P value
|
Gender
|
|
|
|
|
|
|
|
|
Male
|
1.23 (1.12-1.36)
|
<0.001
|
1.19 (1.10-1.29)
|
<0.001
|
1.19 (1.1-1.27)
|
<0.001
|
1.19 (1.12-1.27)
|
<0.001
|
Female
|
Ref
|
|
Ref
|
|
Ref
|
|
Ref
|
|
BMI
|
|
|
|
|
|
|
|
|
<18.5
|
1.52 (1.3-1.78)
|
<0.001
|
2.51 (1.88-3.36)
|
<0.001
|
2.02 (1.63-2.5)
|
<0.001
|
1.68 (1.39-2.02)
|
<0.001
|
18.5-24.9
|
Ref
|
|
Ref
|
|
Ref
|
|
Ref
|
|
25-29.9
|
0.58 (0.43-0.77)
|
<0.001
|
0.61 (0.49-0.77)
|
<0.001
|
0.66 (0.55-0.79)
|
<0.001
|
0.69 (0.6-0.79)
|
<0.001
|
30+
|
0.50 (0.37-0.69)
|
<0.001
|
0.55 (0.42-0.71)
|
<0.001
|
0.62 (0.52-0.75)
|
<0.001
|
0.69 (0.58-0.82)
|
<0.001
|
Age
|
|
|
|
|
|
|
|
|
20-35
|
1.23 (1.12-1.35)
|
<0.001
|
1.36 (1.26-1.47)
|
<0.001
|
1.47 (1.37-1.57)
|
<0.001
|
1.49 (1.40-1.59)
|
<0.001
|
36-50
|
Ref
|
|
Ref
|
|
Ref
|
|
Ref
|
|
51+
|
1.03 (0.88-1.2)
|
0.719
|
1.00 (0.87-1.14)
|
0.960
|
0.98 (0.87-1.1)
|
0.665
|
0.99 (0.89-1.10)
|
0.803
|
Marital Status
|
|
|
|
|
|
|
|
|
Single
|
1.34 (1.19-1.51)
|
<0.001
|
1.31 (1.18-1.45)
|
<0.001
|
1.26 (1.15-1.38)
|
<0.001
|
1.34 (1.23-1.45)
|
<0.001
|
Divorced
|
1.35 (1.19-1.53)
|
<0.001
|
1.31 (1.17-1.46)
|
<0.001
|
1.30 (1.19-1.43)
|
<0.001
|
1.25 (1.15-1.36)
|
<0.001
|
Married
|
Ref
|
|
Ref
|
|
Ref
|
|
Ref
|
|
Widowed
|
1.01 (0.87-1.18)
|
0.859
|
0.99 (0.87-1.12)
|
0.814
|
1.02 (0.91-1.14)
|
0.726
|
1.03 (0.93-1.14)
|
0.555
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
CD4
|
|
|
|
|
|
|
|
|
0-250
|
1.34 (1.16-1.55)
|
<0.001
|
1.33 (1.17-1.5)
|
<0.001
|
1.15 (1.05-1.27)
|
0.004
|
1.18 (1.08-1.29)
|
<0.001
|
251-500
|
Ref
|
|
Ref
|
|
Ref
|
|
Ref
|
|
Above 500
|
1.42 (0.81-2.49)
|
0.215
|
1.22 (0.73-2.05)
|
0.448
|
1.42 (0.93-2.16)
|
0.102
|
1.33 (0.90-1.96)
|
0.149
|
Regimen Started
|
|
|
|
|
|
|
|
|
D4T-based
|
Ref
|
|
Ref
|
|
Ref
|
|
Ref
|
|
ABC-based
|
2.37 (1.82-3.08)
|
<0.001
|
2.44 (1.93-3.09)
|
<0.001
|
2.33 (1.87-2.90)
|
<0.001
|
2.17 (1.75-2.69)
|
<0.001
|
AZT-based
|
0.74 (0.65-0.83)
|
<0.001
|
0.75 (0.67-0.83)
|
<0.001
|
0.78 (0.71-0.85)
|
<0.001
|
0.85 (0.79-0.93)
|
<0.001
|
TDF-based
|
0.62 (0.55-0.69)
|
<0.001
|
0.67 (0.61-0.74)
|
<0.001
|
0.73 (0.68-0.8)
|
<0.001
|
0.86 (0.80-0.92)
|
<0.001
|
Baseline WHO Stage
|
|
|
|
|
|
|
|
|
Stage I
|
Ref
|
|
Ref
|
|
Ref
|
|
Ref
|
|
Stage II
|
1.03 (0.87-1.22)
|
0.732
|
1.08 (0.95-1.24)
|
0.242
|
1.07 (0.96-1.19)
|
0.251
|
1.07 (0.98-1.17)
|
0.147
|
Stage III
|
1.34 (1.14-1.57)
|
<0.001
|
1.31 (1.16-1.48)
|
<0.001
|
1.25 (1.13-1.39)
|
<0.001
|
1.22 (1.12-1.34)
|
<0.001
|
Stage IV
|
1.83 (1.48-2.26)
|
<0.001
|
1.57 (1.31-1.88)
|
<0.001
|
1.38 (1.17-1.62)
|
<0.001
|
1.34 (1.15-1.57)
|
<0.001
|
|
|
|
|
|
|
|
|
|