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    Factors Associated with Outcomes of Pre-ART HIV Care

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    Author
    Stafford, K.A.
    Nganga, L.W.
    Tulli, T.
    Date
    2018
    Journal
    Journal of the International Association of Providers of AIDS Care
    Publisher
    SAGE Publications Inc.
    Type
    Article
    
    Metadata
    Show full item record
    See at
    https://dx.doi.org/10.1177/2325958218759602
    Abstract
    The World Health Organization recommended removing all CD4 requirements for initiation of antiretroviral therapy (ART) in resource-limited settings. We examined the pre-ART period to identify and assess factors associated with outcomes of pre-ART care. Four modes of transition out of pre-ART care were considered. Beta estimates from the competing risks Cox models were used to investigate whether the effects of covariates differed by mode of transition. Median CD4 counts at entry showed no meaningful change over time. Advanced disease progression and presence of opportunistic infections were significant predictors of pre-ART mortality. Men were more likely to die before initiating ART, transfer to another facility, or be lost to follow-up than were women. Removing CD4 thresholds is not likely to substantially reduce program mortality prior to ART initiation unless and until patients enroll earlier in disease progression. Care programs should focus on diagnosis and treatment of opportunistic infections to reduce pre-ART mortality. Copyright The Author(s) 2018.
    Keyword
    competing risks analysis
    HIV
    opportunistic infections
    pre-ART period
    treatment guidelines
    Identifier to cite or link to this item
    https://www.scopus.com/inward/record.uri?eid=2-s2.0-85059188340&doi=10.1177%2f2325958218759602&partnerID=40&md5=dad1768ef97d5956c44cdf6cceb21c1a; http://hdl.handle.net/10713/8953
    ae974a485f413a2113503eed53cd6c53
    10.1177/2325958218759602
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