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15th Annual Conference of the British HIV Association1-3 April 2009, Liverpool, UK |
A COHORT ANALYSIS OF TREATMENT OUTCOMES FROM THE LARGEST PROVIDER OF ANTIRETROVIRAL TREATMENT IN BURMA
HIV Med 2009 Apr 1-3; 10(Suppl. 1):10 (abstract no. O19)
K Sabapathy1, M Kyaw-Kyaw2 and F Smithuis2
1London School of Hygiene and Tropical Medicine, London, UK, 2Me´decins Sans Frontie`res, Yangon, Myanmar
BACKGROUND: HIV prevalence in Burma is approximately 1%, over 76,000 people need ART, while approximately 15,000 people receive it. 25,000 AIDS deaths occurred in 2007. In 2003, an international non-governmental organisation pioneered ART provision in this challenging environment with limited healthcare resources and now delivers two-thirds of national ART coverage.
AIMS: To analyse the long-term survival and retention under care of patients on ART; and to describe outcomes from a country on which little is published in the medical literature.
METHODS: From 2003 to mid-2008 approximately 16,000 HIV-positive patients have been enrolled for care and 10,642 have started ART in 13 sites. Baseline data collection included age, sex and WHO stage, and CD4 count since 2005. Survival analysis methods were used to estimate loss to follow-up and survival on ART, stratified by year of starting treatment, and separately for WHO stage 4 patients.
RESULTS: All 10,642 patients were analysed. 42% were female and the median age was 32 y. Among patients who started ART in each of 2004, 2005 & 2006, the survival probabilities at 24 months were 83%, 85% and 88% respectively, with loss to follow up at 24 m of ≤5% in all years. The 36 m survival probabilities for 2004 and 2005 were 81% and 83% respectively, with loss to follow-up of ≤7%. 40% of patients were in WHO stage 4 at baseline, and within this group there was very strong evidence that the probability of survival increased over time (P<0.001, log-rank test), with a 24 m survival probability of 75% in 2004, 79% in 2005, and 84% in 2006.
CONCLUSIONS: The programme has successfully scaled-up ART provision in Burma and progressively improved outcomes of the most advanced patients. Survival and loss to follow-up data compare favourably with those of other resource-limited settings, despite high levels of severe immuno-suppression and treatment provision entirely at the primary care level. Nonetheless, the unmet need for ART remains high, and requires urgent attention.
2009-04-01
O19
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