The effect of antiretroviral therapy guideline change on health outcomes among youth living with HIV in Uganda

Hilda Sekabira Nakalema, Suja S. Rajan, Robert O. Morgan, Minjae Lee, Susan L. Gillespie, Adeodata Kekitiinwa

Research output: Contribution to journalArticlepeer-review

Abstract

Opportunistic infections (OIs) are the primary cause of HIV-related morbidity and mortality. To reduce the risk, the ART eligibility criteria were revised to start treatment before advanced disease onset. We evaluated the effect of 2014 HIV clinical guideline changes in Uganda on opportunistic infections and survival among Youth Living with HIV (YLWH). This retrospective cohort analysis used administrative data from the District Health Information System (DHIS2) and the national referral hospital, to compare YLWH, 15–24 years old, who started ART pre-guideline (January 2012–June 2014) and post-guideline (July 2014–December 2016). We assessed the effect using multivariable logistic and Cox Proportional Hazards regression models, respectively. Post-guideline youth had 18% and 30% lower adjusted odds of having an OI at 6 (aOR: 0.82, 95%CI: 0.67, 0.99), and 12 months (aOR: 0.70, 95%CI: 0.58, 0.85) after ART initiation, compared to pre-guideline youth. No significant differences were observed in survival probabilities (Z = 2.56, P-value = 0.11) and adjusted hazard ratios (aHR: 1.55, 95%CI: 0.46, 5.28). Early ART initiation reduced the risk of OIs among YLWH. However, given the existence of geographical and clinical variations in the endemicity, morbidity and mortality associated with different OIs, additional research is still needed.

Original languageEnglish (US)
Pages (from-to)904-913
Number of pages10
JournalAIDS Care - Psychological and Socio-Medical Aspects of AIDS/HIV
Volume33
Issue number7
DOIs
StatePublished - 2021
Externally publishedYes

Keywords

  • antiretroviral therapy
  • HIV
  • opportunistic infections
  • survival
  • Uganda
  • youth

ASJC Scopus subject areas

  • Health(social science)
  • Social Psychology
  • Public Health, Environmental and Occupational Health

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