AEGiS-13IAC: Challenges for Sustaining Long-term Care and Follow-up for HIV infected Persons on Sophisticated Antiretoviral Therapy in a Developing Country u Uganda.

13th International AIDS Conference

Durban, South Africa - July 9-July 14, 2000

Challenges for Sustaining Long-term Care and Follow-up for HIV infected Persons on Sophisticated Antiretoviral Therapy in a Developing Country u Uganda.

Int Conf AIDS 2000 Jul 9-14; 13:(abstract no. TuOrB294)

Mwebaze R, Sozi C, Bahendeka S, Mwebe D, Moss V, Rukundo G, Katabira E, Malamba S, Weidle P, Ochola D, Lackritz E
R. Mwebaze, Nsambya Hospital, c/o UNAIDS, c/o WHO, P.O. Box 24578, Kampala, Uganda, Tel.: +256-41-340-114, Fax: +256-41-340-113, E-mail: malambas@infocom.co.ug

BACKGROUND: The UNAIDS HIV Drug Access Initiative (DAI) is a pilot program intended to increase the access to AIDS care and drugs, including antiretroviral (ARV) drugs, in developing countries. We analyzed the sustainability of ARV therapy within the DAI in Uganda.

METHODS: Patients (pts) who accessed the DAI between 1-Aug-98 and 31-Dec-99 at 3 sites were included. Pt status was determined from the clinical record and the staff at each site and was categorized as 1) active/on ARV, 2) known to have died, 3) stopped ARV, 4) transferred care/still on ARV, 5) moved from the region, and 6) lost to follow-up (LTFU).

RESULTS: Data from 263 pts (48% women) - median CD4 count of 75 cells/mm³ and viral load of 164,162 copies/ml - were included. Initial ARV therapy was 2 nucleoside reverse transcriptase inhibitors ± hydroxyurea (2NRTI) for 159 (60%) and 2 NRTI plus a nonnucleoside RTI or a protease inhibitor (HAART) for 104 (40%). As of 31-Dec-99 the pts' status was active/on ARV for 143 (55%), LTFU for 49 (19%), known to have died for 39 (15%), stopped ARV for 13 (5%), transferred care/still on ARV for 11 (4%), and moved from the region for 8 (3%). Of the 39 deaths, the physician reported reason was AIDS-related for 25 (64%), non-AIDS related for 2 (5%) and unknown for 12 (31%). For the 13 who stopped ARV, the reasons were financial for 7 (54%) and other/unknown for 6 (46%). The probability of remaining active/on ARV was 60% at 6 months, 45% at 12 months, and 35% at 15 months. For pts not LTFU, the probability of remaining alive was 83% at 6 months, 77% at 12 months, and 73% at 15 months.

CONCLUSIONS: Many pts with advanced HIV disease sustained ARV therapy for more than one year. However, mortality and loss to follow-up rates are relatively high. As programs progress to provide sophisticated drugs for the treatment of HIV/AIDS in developing countries, efforts to sustain therapy will require developing solutions for the reasons for discontinuing care.

Keywords: AEGIS, HIV Infections, Reverse Transcriptase Inhibitors, Antiretroviral Therapy, Highly Active, Developing Countries, CD4 Lymphocyte Count, Viral Load, Acquired Immunodeficiency Syndrome, HIV Seropositivity, Uganda, Human, Female, therapy, drug therapy
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