Journal
TROPICAL MEDICINE & INTERNATIONAL HEALTH
Volume 17, Issue 8, Pages e3-e14Publisher
WILEY
DOI: 10.1111/j.1365-3156.2011.02943.x
Keywords
antiretroviral therapy; lifetable models; AIDS; HIV; cohort studies; mortality; Africa
Funding
- Wellcome Trust, UK
- Wellcome Trust
- Tanzanian Ministry of Health and Social Welfare through a grant from the Global Fund for AIDS, TB and Malari
- UK Medical Research Council
- Wellcome Trust, UK [082384/Z/07/Z]
- US President's Emergency Plan for AIDS
- MRC [G0902143, G0700837] Funding Source: UKRI
- Medical Research Council [G0700837, G0902143] Funding Source: researchfish
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Objectives To present a simple method for estimating population-level anti-retroviral therapy (ART) need that does not rely on knowledge of past HIV incidence. Methods A new approach to estimating ART need is developed based on calculating age-specific proportions of HIV-infected adults expected to die within a fixed number of years in the absence of treatment. Mortality data for HIV-infected adults in the pre-treatment era from five African HIV cohort studies were combined to construct a life table, starting at age 15, smoothed with a Weibull model. Assuming that ART should be made available to anyone expected to die within 3 years, conditional 3-year survival probabilities were computed to represent proportions needing ART. The build-up of ART need in a successful programme continuously recruiting infected adults into treatment as they age to within 3 years of expected death was represented by annually extending the conditional survival range. Results The Weibull model: survival probability in the infected state from age 15 = exp(-0.0073 x (age - 15)1.69) fitted the pooled age-specific mortality data very closely. Initial treatment need for infected persons increased rapidly with age, from 15% at age 2024 to 32% at age 4044 and 42% at age 6064. Overall need in the treatment of naive population was 24%, doubling within 5 years in a programme continually recruiting patients entering the high-risk period for dying. Conclusion A reasonable projection of treatment need in an ART naive population can be made based on the age and gender profile of HIV-infected people.
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