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Diminishing availability of publicly funded slots for antiretroviral initiation among HIV-infected ART-eligible patients in Uganda.

Geng EH, Bwana MB, Kabakyenga J, Muyindike W, Emenyonu NI, Musinguzi N, Mugyenyi P, Martin JN, Bangsberg DR - PLoS ONE (2010)

Bottom Line: We evaluated ART-eligible patients and patients starting ART at a prototypical scale up ART clinic in Mbarara, Uganda between April 1, 2009 and May 14, 2010 where four stakeholders sponsor treatment - two PEPFAR implementing organizations, the Ugandan Ministry of Health - Global Fund (MOH-GF) and a private foundation named the Family Treatment Fund (FTF).Becoming eligible for ART in the 3(rd) (HR = 0.58, 95% 0.45-0.74) and 4(th) quartiles (HR = 0.49, 95% CI: 0.36-0.65) was associated with delay in ART initiation compared to the first quartile in multivariable analyses.During a period of flat line funding from multinational donors for ART programs, reductions in the number of ART initiations by public programs (i.e., PEPFAR and MOH-GF) and delays in ART initiation became apparent at the a large prototypical scale-up ART clinic in Uganda.

View Article: PubMed Central - PubMed

Affiliation: Division of HIV/AIDS, Department of Medicine, San Francisco General Hospital, San Francisco, California, USA.

ABSTRACT

Background: The impact of flat-line funding in the global scale up of antiretroviral therapy (ART) for HIV-infected patients in Africa has not yet been well described.

Methods: We evaluated ART-eligible patients and patients starting ART at a prototypical scale up ART clinic in Mbarara, Uganda between April 1, 2009 and May 14, 2010 where four stakeholders sponsor treatment - two PEPFAR implementing organizations, the Ugandan Ministry of Health - Global Fund (MOH-GF) and a private foundation named the Family Treatment Fund (FTF). We assessed temporal trends in the number of eligible patients, the number starting ART and tabulated the distribution of the stakeholders supporting ART initiation by month and quartile of time during this interval. We used survival analyses to assess changes in the rate of ART initiation over calendar time.

Findings: A total of 1309 patients who were eligible for ART made visits over the 14 month period of the study and of these 819 started ART. The median number of ART eligible patients each month was 88 (IQR: 74 to 115). By quartile of calendar time, PEPFAR and MOH sponsored 290, 192, 180, and 49 ART initiations whereas the FTF started 1, 2, 1 and 104 patients respectively. By May of 2010 (the last calendar month of observation) FTF sponsored 88% of all ART initiations. Becoming eligible for ART in the 3(rd) (HR = 0.58, 95% 0.45-0.74) and 4(th) quartiles (HR = 0.49, 95% CI: 0.36-0.65) was associated with delay in ART initiation compared to the first quartile in multivariable analyses.

Interpretation: During a period of flat line funding from multinational donors for ART programs, reductions in the number of ART initiations by public programs (i.e., PEPFAR and MOH-GF) and delays in ART initiation became apparent at the a large prototypical scale-up ART clinic in Uganda.

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Time from eligibility for ART (as determined by Ugandan National ART Guidelines of a CD4 count less than or equal to 250 cells/mm3) to initiation of ART.The denominator in this analysis is restricted to the subset of patients who became eligible for ART for the first time between April 1, 2009 and May 14, 2010.
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pone-0014098-g003: Time from eligibility for ART (as determined by Ugandan National ART Guidelines of a CD4 count less than or equal to 250 cells/mm3) to initiation of ART.The denominator in this analysis is restricted to the subset of patients who became eligible for ART for the first time between April 1, 2009 and May 14, 2010.

Mentions: We conducted an analysis of time to ART initiation among 697 of 1309 patients who became eligible for the first time during the interval between April 1, 2009 and May 14th, 2010. The number who became eligible in the first through fourth quartiles respectively was: 168 (24%), 199 (29%), 156 (22%) and 174 (25%). The three month cumulative incidence of ART initiation in quartiles 1–4 respectively were 71% (95% CI: 64%–78%), 64% (95% CI: 57%–70%), 49% (42%–57%) and 47% (95% CI: 38%–57%). The log-rank test for equality of survivor functions was significant at p<0.001 (Figure 3). In a Cox model adjusting for age, sex and baseline CD4 value, the rate of ART initiation in the second quartile was 0.93 (95% CI: 0.74–1.18), in the third quartile was 0.61 (95% CI: 0.47–0.80) and in the fourth quartile was 0.53 (95% CI: 0.39–0.73) when compared to the first quartile. Age and sex were not significantly associated with the rate of ART initiation, but a baseline CD4 value of 0–50 cells/cc3 was associated with an increased rate of ART initiation (HR = 1.43, 95% CI: 1.12–1.83) compared to the reference group of baseline CD4 from 150–250 cells/cc3 (Table 1).


Diminishing availability of publicly funded slots for antiretroviral initiation among HIV-infected ART-eligible patients in Uganda.

Geng EH, Bwana MB, Kabakyenga J, Muyindike W, Emenyonu NI, Musinguzi N, Mugyenyi P, Martin JN, Bangsberg DR - PLoS ONE (2010)

Time from eligibility for ART (as determined by Ugandan National ART Guidelines of a CD4 count less than or equal to 250 cells/mm3) to initiation of ART.The denominator in this analysis is restricted to the subset of patients who became eligible for ART for the first time between April 1, 2009 and May 14, 2010.
© Copyright Policy
Related In: Results  -  Collection

Show All Figures
getmorefigures.php?uid=PMC2991339&req=5

pone-0014098-g003: Time from eligibility for ART (as determined by Ugandan National ART Guidelines of a CD4 count less than or equal to 250 cells/mm3) to initiation of ART.The denominator in this analysis is restricted to the subset of patients who became eligible for ART for the first time between April 1, 2009 and May 14, 2010.
Mentions: We conducted an analysis of time to ART initiation among 697 of 1309 patients who became eligible for the first time during the interval between April 1, 2009 and May 14th, 2010. The number who became eligible in the first through fourth quartiles respectively was: 168 (24%), 199 (29%), 156 (22%) and 174 (25%). The three month cumulative incidence of ART initiation in quartiles 1–4 respectively were 71% (95% CI: 64%–78%), 64% (95% CI: 57%–70%), 49% (42%–57%) and 47% (95% CI: 38%–57%). The log-rank test for equality of survivor functions was significant at p<0.001 (Figure 3). In a Cox model adjusting for age, sex and baseline CD4 value, the rate of ART initiation in the second quartile was 0.93 (95% CI: 0.74–1.18), in the third quartile was 0.61 (95% CI: 0.47–0.80) and in the fourth quartile was 0.53 (95% CI: 0.39–0.73) when compared to the first quartile. Age and sex were not significantly associated with the rate of ART initiation, but a baseline CD4 value of 0–50 cells/cc3 was associated with an increased rate of ART initiation (HR = 1.43, 95% CI: 1.12–1.83) compared to the reference group of baseline CD4 from 150–250 cells/cc3 (Table 1).

Bottom Line: We evaluated ART-eligible patients and patients starting ART at a prototypical scale up ART clinic in Mbarara, Uganda between April 1, 2009 and May 14, 2010 where four stakeholders sponsor treatment - two PEPFAR implementing organizations, the Ugandan Ministry of Health - Global Fund (MOH-GF) and a private foundation named the Family Treatment Fund (FTF).Becoming eligible for ART in the 3(rd) (HR = 0.58, 95% 0.45-0.74) and 4(th) quartiles (HR = 0.49, 95% CI: 0.36-0.65) was associated with delay in ART initiation compared to the first quartile in multivariable analyses.During a period of flat line funding from multinational donors for ART programs, reductions in the number of ART initiations by public programs (i.e., PEPFAR and MOH-GF) and delays in ART initiation became apparent at the a large prototypical scale-up ART clinic in Uganda.

View Article: PubMed Central - PubMed

Affiliation: Division of HIV/AIDS, Department of Medicine, San Francisco General Hospital, San Francisco, California, USA.

ABSTRACT

Background: The impact of flat-line funding in the global scale up of antiretroviral therapy (ART) for HIV-infected patients in Africa has not yet been well described.

Methods: We evaluated ART-eligible patients and patients starting ART at a prototypical scale up ART clinic in Mbarara, Uganda between April 1, 2009 and May 14, 2010 where four stakeholders sponsor treatment - two PEPFAR implementing organizations, the Ugandan Ministry of Health - Global Fund (MOH-GF) and a private foundation named the Family Treatment Fund (FTF). We assessed temporal trends in the number of eligible patients, the number starting ART and tabulated the distribution of the stakeholders supporting ART initiation by month and quartile of time during this interval. We used survival analyses to assess changes in the rate of ART initiation over calendar time.

Findings: A total of 1309 patients who were eligible for ART made visits over the 14 month period of the study and of these 819 started ART. The median number of ART eligible patients each month was 88 (IQR: 74 to 115). By quartile of calendar time, PEPFAR and MOH sponsored 290, 192, 180, and 49 ART initiations whereas the FTF started 1, 2, 1 and 104 patients respectively. By May of 2010 (the last calendar month of observation) FTF sponsored 88% of all ART initiations. Becoming eligible for ART in the 3(rd) (HR = 0.58, 95% 0.45-0.74) and 4(th) quartiles (HR = 0.49, 95% CI: 0.36-0.65) was associated with delay in ART initiation compared to the first quartile in multivariable analyses.

Interpretation: During a period of flat line funding from multinational donors for ART programs, reductions in the number of ART initiations by public programs (i.e., PEPFAR and MOH-GF) and delays in ART initiation became apparent at the a large prototypical scale-up ART clinic in Uganda.

Show MeSH