ArticlePloS one2013
Monitoring of antiretroviral therapy and mortality in HIV programmes in Malawi, South Africa and Zambia: mathematical modelling study.
Article in PloS one, 2013. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 24 papers, 3 of them syntheses that pooled it.
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Who cites it
24 citing papers in PubMed, 3 syntheses or guidelines pooled it.
- Factors associated with antiretroviral treatment failure among people living with HIV on antiretroviral therapy in resource-poor settings: a systematic review and metaanalysis.Systematic reviews · 2020Pooled it
- Feasibility of antiretroviral treatment monitoring in the era of decentralized HIV care: a systematic review.AIDS research and therapy · 2017Pooled it
- The impact of physician-nurse task shifting in primary care on the course of disease: a systematic review.Human resources for health · 2015Pooled it
- Routine versus Targeted Viral Load Strategy among Patients Starting Antiretroviral in Hanoi, Vietnam.Journal of the International AIDS Society · 2019Trial
- Can combination prevention strategies reduce HIV transmission in generalized epidemic settings in Africa? The HPTN 071 (PopART) study plan in South Africa and Zambia.Journal of acquired immune deficiency syndromes (1999) · 2013Trial
- Article
- Designing a Predictive Model for Antiretroviral Regimen at the Antiretroviral Therapy Center in Chiro Hospital, Ethiopia.Journal of healthcare engineering · 2021Article
- The role of HIV viral load in mathematical models of HIV transmission and treatment: a review.BMJ global health · 2020Review
- Global variations in mortality in adults after initiating antiretroviral treatment: an updated analysis of the International epidemiology Databases to Evaluate AIDS cohort collaboration.AIDS (London, England) · 2019Article
- The Effect of Monitoring Viral Load and Tracing Patients Lost to Follow-up on the Course of the HIV Epidemic in Malawi: A Mathematical Model.Open forum infectious diseases · 2018Article
- A targeted approach for routine viral load monitoring in Malawian adults on antiretroviral therapy.Tropical medicine & international health : TM & IH · 2018Article
- Assessment of WHO criteria for identifying ART treatment failure in Vietnam from 2007 to 2011.PloS one · 2017Article
- Laboratory Monitoring of Antiretroviral Therapy for HIV Infection: Cost-Effectiveness and Budget Impact of Current and Novel Strategies.Clinical infectious diseases : an official publication of the Infectious Diseases Society of America · 2016Article
- The need for second-line antiretroviral therapy in adults in sub-Saharan Africa up to 2030: a mathematical modelling study.The lancet. HIV · 2016Article
- HIV Infection and AIDS in Sub-Saharan Africa: Current Status, Challenges and Opportunities.The open AIDS journal · 2016Article
- Article
- Age-specific and sex-specific weight gain norms to monitor antiretroviral therapy in children in low-income and middle-income countries.AIDS (London, England) · 2015Article
- Article
- Article
- Viral load versus CD4⁺ monitoring and 5-year outcomes of antiretroviral therapy in HIV-positive children in Southern Africa: a cohort-based modelling study.AIDS (London, England) · 2014Article
Corrections and comments
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Authors and funding
13 authors.
Funding
Abstract
objectivesMortality in patients starting antiretroviral therapy (ART) is higher in Malawi and Zambia than in South Africa. We examined whether different monitoring of ART (viral load [VL] in South Africa and CD4 count in Malawi and Zambia) could explain this mortality difference.
designMathematical modelling study based on data from ART programmes.
methodsWe used a stochastic simulation model to study the effect of VL monitoring on mortality over 5 years. In baseline scenario A all parameters were identical between strategies except for more timely and complete detection of treatment failure with VL monitoring. Additional scenarios introduced delays in switching to second-line ART (scenario B) or higher virologic failure rates (due to worse adherence) when monitoring was based on CD4 counts only (scenario C). Results are presented as relative risks (RR) with 95% prediction intervals and percent of observed mortality difference explained.
resultsRRs comparing VL with CD4 cell count monitoring were 0.94 (0.74-1.03) in scenario A, 0.94 (0.77-1.02) with delayed switching (scenario B) and 0.80 (0.44-1.07) when assuming a 3-times higher rate of failure (scenario C). The observed mortality at 3 years was 10.9% in Malawi and Zambia and 8.6% in South Africa (absolute difference 2.3%). The percentage of the mortality difference explained by VL monitoring ranged from 4% (scenario A) to 32% (scenarios B and C combined, assuming a 3-times higher failure rate). Eleven percent was explained by non-HIV related mortality.
conclusionsVL monitoring reduces mortality moderately when assuming improved adherence and decreased failure rates.
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