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Open Access Highly Accessed Research article

Reviewing progress: 7 year trends in characteristics of adults and children enrolled at HIV care and treatment clinics in the United Republic of Tanzania

Harriet Nuwagaba-Biribonwoha12*, Bonita Kilama3, Gretchen Antelman1, Ahmed Khatib4, Annette Almeida1, William Reidy1, Gongo Ramadhani5, Matthew R Lamb12, Redempta Mbatia6, Elaine J Abrams12 and for the Identifying Optimal Models of HIV Care and Treatment in Sub-Saharan Africa Consortium, United Republic of Tanzania

Author Affiliations

1 ICAP-Columbia University, Mailman School of Public Health, 535 W 116th Street, New York, NY, 10027, USA

2 Department of Epidemiology, Columbia University, Mailman School of Public Health, 535 W 116th Street, New York, NY, 10027, USA

3 National AIDS Control Program, P.O. BOX 11857, Dar es Salaam, United Republic of Tanzania

4 Zanzibar AIDS Control Program, P. O. Box 236, Unguja Zanzibar, United Republic of Tanzania

5 Centers for Disease Control, P.O. Box 9123, Dar es Salaam, Tanzania

6 Tanzania Health Promotion Support, P.O. BOX 32605, Dar es Salaam, Tanzania

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BMC Public Health 2013, 13:1016  doi:10.1186/1471-2458-13-1016

Published: 27 October 2013

Abstract

Background

To evaluate the on-going scale-up of HIV programs, we assessed trends in patient characteristics at enrolment and ART initiation over 7 years of implementation.

Methods

Data were from Optimal Models, a prospective open cohort study of HIV-infected (HIV+) adults (≥15 years) and children (<15 years) enrolled from January 2005 to December 2011 at 44 HIV clinics in 3 regions of mainland Tanzania (Kagera, Kigoma, Pwani) and Zanzibar. Comparative statistics for trends in characteristics of patients enrolled in 2005–2007, 2008–2009 and 2010–2011 were examined.

Results

Overall 62,801 HIV + patients were enrolled: 58,102(92.5%) adults, (66.5% female); 4,699(7.5%) children.

Among adults, pregnant women enrolment increased: 6.8%, 2005–2007; 12.1%, 2008–2009; 17.2%, 2010–2011; as did entry into care from prevention of mother-to-child HIV transmission (PMTCT) programs: 6.6%, 2005–2007; 9.5%, 2008–2009; 12.6%, 2010–2011

. WHO stage IV at enrolment declined: 27.1%, 2005–2007; 20.2%, 2008–2009; 11.1% 2010–2011. Of the 42.5% and 29.5% with CD4+ data at enrolment and ART initiation respectively, median CD4+ count increased: 210 cells/μL, 2005–2007; 262 cells/μL, 2008–2009; 266 cells/μL 2010–2011; but median CD4+ at ART initiation did not change (148 cells/μL overall). Stavudine initiation declined: 84.9%, 2005–2007; 43.1%, 2008–2009; 19.7%, 2010–2011.

Among children, median age (years) at enrolment decreased from 6.1(IQR:2.7-10.0) in 2005–2007 to 4.8(IQR:1.9-8.6) in 2008–2009, and 4.1(IQR:1.5-8.1) in 2010–2011 and children <24 months increased from 18.5% to 26.1% and 31.5% respectively. Entry from PMTCT was 7.0%, 2005–2007; 10.7%, 2008–2009; 15.0%, 2010–2011. WHO stage IV at enrolment declined from 22.9%, 2005–2007, to 18.3%, 2008–2009 to 13.9%, 2010–2011. Proportion initiating stavudine was 39.8% 2005–2007; 39.5%, 2008–2009; 26.1%, 2010–2011. Median age at ART initiation also declined significantly.

Conclusions

Over time, the proportion of pregnant women and of adults and children enrolled from PMTCT programs increased. There was a decline in adults and children with advanced HIV disease at enrolment and initiation of stavudine. Pediatric age at enrolment and ART initiation declined. Results suggest HIV program maturation from an emergency response.

Keywords:
ART program; HIV-infected adults; HIV-infected children; Trends at enrolment; Trends at ART initiation; Tanzania