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Anti-retroviral treatment outcomes among older adults in Zomba district, Malawi.

Negin J, van Lettow M, Semba M, Martiniuk A, Chan A, Cumming RG - PLoS ONE (2011)

Bottom Line: In the proportional hazards model, after controlling for sex and stage at initiation, survival in those aged 50-59 did not differ significantly from those aged 25-49 (hazard ratio 1.00 (95% CI: 0.79 to 1.27; P = 0.998) but the hazard ratio was 1.46 (95% CI: 1.03 to 2.06; P = 0.032) for those aged 60 and older compared to those aged 25-49.Treatment outcomes of those aged 50-59 are similar to those aged 25-49.A better understanding of how older adults present for and respond to treatment is critical to improving HIV services.

View Article: PubMed Central - PubMed

Affiliation: School of Public Health, University of Sydney, Sydney, Australia. joel.negin@sydney.edu.au

ABSTRACT

Background: There are approximately 3 million people aged 50 and older in sub-Saharan Africa who are HIV-positive. Despite this, little is known about the characteristics of older adults who are on treatment and their treatment outcomes.

Methods: A retrospective cohort analysis was performed using routinely collected data with Malawi Ministry of Health monitoring tools from facilities providing antiretroviral therapy services in Zomba district. Patients aged 25 years and older initiated on treatment from July 2005 to June 2010 were included. Differences in survival, by age group, were determined using Kaplan-Meier survival plots and Cox proportional hazards regression models.

Results: There were 10,888 patients aged 25 and older. Patients aged 50 and older (N = 1419) were more likely to be male (P<0.0001) and located in rural areas (P = 0.003) than those aged 25-49. Crude survival estimates among those aged 50-59 were not statistically different from those aged 25-49 (P = 0.925). However, survival among those aged 60 and older (N = 345) was worse (P = 0.019) than among those 25-59. In the proportional hazards model, after controlling for sex and stage at initiation, survival in those aged 50-59 did not differ significantly from those aged 25-49 (hazard ratio 1.00 (95% CI: 0.79 to 1.27; P = 0.998) but the hazard ratio was 1.46 (95% CI: 1.03 to 2.06; P = 0.032) for those aged 60 and older compared to those aged 25-49.

Conclusions: Treatment outcomes of those aged 50-59 are similar to those aged 25-49. A better understanding of how older adults present for and respond to treatment is critical to improving HIV services.

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Related in: MedlinePlus

Survival estimates by age.Kaplan-Meier survival estimates by age group for those aged 25 and older who initiated treatment in Zomba District between 1 July 2005 and 30 June 2010. Blue is 25–49 (N = 7297); Red is 50–59 (N = 839); Green is 60+ (N = 276).
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pone-0026546-g001: Survival estimates by age.Kaplan-Meier survival estimates by age group for those aged 25 and older who initiated treatment in Zomba District between 1 July 2005 and 30 June 2010. Blue is 25–49 (N = 7297); Red is 50–59 (N = 839); Green is 60+ (N = 276).

Mentions: Data were available for 8412 individuals for the analysis of treatment outcomes. Of these, 765 (9.1%) died within 5 years of initiation of treatment. Survival rates among those aged 50–59 were not statistically different from those aged 25–49 (P = 0.92) (figure 1). Survival among those aged 60 and older was significantly worse (P = 0.02) than among those 25–59. Those aged 60 and older also had significantly worse survival (P = 0.04) than those aged 50–59. Further analysis revealed that sex was a significant predictor of survival (P<0.0001), with males having worse survival than females (figure 2).


Anti-retroviral treatment outcomes among older adults in Zomba district, Malawi.

Negin J, van Lettow M, Semba M, Martiniuk A, Chan A, Cumming RG - PLoS ONE (2011)

Survival estimates by age.Kaplan-Meier survival estimates by age group for those aged 25 and older who initiated treatment in Zomba District between 1 July 2005 and 30 June 2010. Blue is 25–49 (N = 7297); Red is 50–59 (N = 839); Green is 60+ (N = 276).
© Copyright Policy
Related In: Results  -  Collection

Show All Figures
getmorefigures.php?uid=PMC3198738&req=5

pone-0026546-g001: Survival estimates by age.Kaplan-Meier survival estimates by age group for those aged 25 and older who initiated treatment in Zomba District between 1 July 2005 and 30 June 2010. Blue is 25–49 (N = 7297); Red is 50–59 (N = 839); Green is 60+ (N = 276).
Mentions: Data were available for 8412 individuals for the analysis of treatment outcomes. Of these, 765 (9.1%) died within 5 years of initiation of treatment. Survival rates among those aged 50–59 were not statistically different from those aged 25–49 (P = 0.92) (figure 1). Survival among those aged 60 and older was significantly worse (P = 0.02) than among those 25–59. Those aged 60 and older also had significantly worse survival (P = 0.04) than those aged 50–59. Further analysis revealed that sex was a significant predictor of survival (P<0.0001), with males having worse survival than females (figure 2).

Bottom Line: In the proportional hazards model, after controlling for sex and stage at initiation, survival in those aged 50-59 did not differ significantly from those aged 25-49 (hazard ratio 1.00 (95% CI: 0.79 to 1.27; P = 0.998) but the hazard ratio was 1.46 (95% CI: 1.03 to 2.06; P = 0.032) for those aged 60 and older compared to those aged 25-49.Treatment outcomes of those aged 50-59 are similar to those aged 25-49.A better understanding of how older adults present for and respond to treatment is critical to improving HIV services.

View Article: PubMed Central - PubMed

Affiliation: School of Public Health, University of Sydney, Sydney, Australia. joel.negin@sydney.edu.au

ABSTRACT

Background: There are approximately 3 million people aged 50 and older in sub-Saharan Africa who are HIV-positive. Despite this, little is known about the characteristics of older adults who are on treatment and their treatment outcomes.

Methods: A retrospective cohort analysis was performed using routinely collected data with Malawi Ministry of Health monitoring tools from facilities providing antiretroviral therapy services in Zomba district. Patients aged 25 years and older initiated on treatment from July 2005 to June 2010 were included. Differences in survival, by age group, were determined using Kaplan-Meier survival plots and Cox proportional hazards regression models.

Results: There were 10,888 patients aged 25 and older. Patients aged 50 and older (N = 1419) were more likely to be male (P<0.0001) and located in rural areas (P = 0.003) than those aged 25-49. Crude survival estimates among those aged 50-59 were not statistically different from those aged 25-49 (P = 0.925). However, survival among those aged 60 and older (N = 345) was worse (P = 0.019) than among those 25-59. In the proportional hazards model, after controlling for sex and stage at initiation, survival in those aged 50-59 did not differ significantly from those aged 25-49 (hazard ratio 1.00 (95% CI: 0.79 to 1.27; P = 0.998) but the hazard ratio was 1.46 (95% CI: 1.03 to 2.06; P = 0.032) for those aged 60 and older compared to those aged 25-49.

Conclusions: Treatment outcomes of those aged 50-59 are similar to those aged 25-49. A better understanding of how older adults present for and respond to treatment is critical to improving HIV services.

Show MeSH
Related in: MedlinePlus