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Population-level trends in the uptake of services and the survival of HIV positives

Population-level trends in the uptake of services and the survival of HIV positives.

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Population-level trends in the uptake of services and the survival of HIV positives

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  1. Population-level trends in the uptake of services and the survival of HIV positives G. Reniers1, E. Slaymaker 1, I. Kasamba 2, A.C. Crampin1, M. Nyirenda3, O. Mugurungi4, M. Urassa5, T. Lutalo2, D. Nabukalu2, A. Aveika5, N. Schur6, V. Hosegood3, M. Chihana1, J. Nakiyingi-Miiro2, E. Mclean1, and B. Zaba1 1 London School of Hygiene and Tropical Medicine, 2 Medical Research Council, Entebbe, 3 Africa Centre for Health and Population Studies, Mtubatuba, 4 Ministry of Health and Child Welfare, Harare, 5 National Institute for Medical Research, Mwanza, 6 Imperial College, London Prepared for the 20th International AIDS Conference, 20-25 July 2014 Melbourne, Australia Abstract TUPDC102- outside room 112

  2. Data and methods • We describe three transitions on the HIV treatment cascade • Seroconversion HTC ART Death • Death is a competing risk in the first two transitions • Analysis I: site-specific trends in the cumulative incidence of: • HTC following seroconversion and death before HTC • ART initiation following HTC and death before ART • Death following ART initiation • Analysis II: site-stratified Cox PH of each outcome to assess gender differences, controlling for age. Seven demographic surveillance sites with: • Repeated population-based testing for HIV • Data on: • Imputed date of seroconversion • First HIV testing and Counselling (HTC) post-seroconversion • Start of treatment • Death Study site locations

  3. Findings • The uptake (both coverage and timing) of HTC and ART has improved very fast in successive cohorts of HIV positive men and women. • Death before diagnosis is limited in most study sites, but non-negligible mortality persists both before and after ART initiation: • Between 4 and 11% still die within 5 years of an HIV+ diagnosis without starting ART • Between 3 and 7% die during the first year of ART • Large gender differences in the uptake of services and treatment outcomes are large. • Men have: • lower uptake of HTC • Twice the level of pre-ART mortality following diagnosis • Twice the mortality on ART • Gender differences have increased over time

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