Table 4.
Predictors of the unfavourable outcome for patients initiated on first‐line ART under Treat‐All and standard of care
| Treat‐All (n = 1888) | SOC (n = 1282) | |||
|---|---|---|---|---|
| Univariate analysis | Multivariate analysisa | Univariate analysis | Multivariate analysisb | |
| HR (95% CI) | aHR (95% CI) | HR (95% CI) | aHR (95% CI) | |
| Implementation periodc | ||||
| Period‐1 | 1 | 1 | 1 | 1 |
| Period‐2 | 1.34 (1.12 to 1.62) | 1.12 (0.92 to 1.36) | 0.70 (0.55 to 0.91) | 0.71 (0.54 to 0.92) |
| Facility | ||||
| PHC | 1 | 1 | 1 | 1 |
| SHCd | 0.93 (0.78 to 1.11) | 0.87 (0.72 to 1.05) | 1.01 (0.81 to 1.28) | 0.94 (0.72 to 1.23) |
| Time since HIV diagnosisa | ||||
| ≥90 days | 1 | 1 | 1 | 1 |
| 1 to 89 days | 1.51 (1.22 to 1.85) | 1.12 (0.86 to 1.46) | 1.72 (1.33 to 2.23) | 1.05 (0.74 to 1.48) |
| Same day | 1.76 (1.39 to 2.23) | 0.98 (0.73 to 1.30) | 2.52 (1.83 to 3.46) | 0.92 (0.59 to 1.44) |
| Time since HIV care enrolmente | ||||
| ≥90 days | 1 | 1 | 1 | 1 |
| 1 to 89 days | 1.99 (1.47 to 2.69) | 1.53 (1.02 to 2.30) | 2.29 (1.62 to 3.24) | 2.07 (1.30 to 3.31) |
| Same day | 2.62 (1.95 to 3.52) | 2.08 (1.42 to 3.06) | 3.71 (2.59 to 5.32) | 3.11 (1.91 to 5.05) |
| Sex | ||||
| Men | 1 | 1 | 1 | 1 |
| Women | 1.25 (1.03 to 1.52) | 1.14 (0.90 to 1.45) | 1.18 (0.92 to 1.50) | 1.03 (0.76 to 1.39) |
| Pregnancy | ||||
| No | 1 | 1 | 1 | 1 |
| Yes | 1.62 (1.36 to 1.94) | 1.37 (1.10 to 1.71) | 1.51 (1.19 to 1.93) | 1.21 (0.88 to 1.68) |
| Age at HIV care enrolment, years | ||||
| 16 to 24 | 1.62 (1.35 to 1.95) | 1.32 (1.08 to 1.63) | 1.83 (1.45 to 2.32) | 1.48 (1.11 to 1.98) |
| 25 to 49 | 1 | 1 | 1 | 1 |
| ≥50 | 0.81 (0.58 to 1.14) | 1.04 (0.72 to 1.50) | 0.88 (0.56 to 1.39) | 1.02 (0.64 to 1.64) |
| Marital status | ||||
| Married | 1 | 1 | 1 | 1 |
| Not married | 1.70 (1.40 to 2.06) | 1.48 (1.20 to 1.81) | 1.62 (1.29 to 2.03) | 1.39 (1.09 to 1.78) |
| Education | ||||
| None | 1 | 1 | 1 | 1 |
| Primary | 1.03 (0.62 to 1.70) | 1.05 (0.62 to 1.77) | 1.05 (0.68 to 1.64) | 1.01 (0.64 to 1.60) |
| Secondary | 1.30 (0.80 to 2.10) | 1.15 (0.68 to 1.94) | 0.99 (0.65 to 1.52) | 0.87 (0.56 to 1.37) |
| Tertiary | 1.54 (0.70 to 3.40) | 1.23 (0.53 to 2.83) | 1.81 (0.82 to 4.00) | 2.15 (0.92 to 5.04) |
| CD4 count, cells/mm3 | ||||
| 0 to 100 | 1.48 (1.14 to 1.93) | 1.48 (1.10 to 1.98) | 1.93 (1.39 to 2.69) | 1.75 (1.19 to 2.55) |
| 101 to 200 | 1.15 (0.87 to 1.53) | 1.19 (0.89 to 1.59) | 1.43 (1.01 to 2.03) | 1.36 (0.94 to 1.99) |
| 201 to 350 | 1 | 1 | 1 | 1 |
| 351 to 500 | 1.05 (0.81 to 1.35) | 1.16 (0.89 to 1.50) | 1.18 (0.84 to 1.66) | 1.37 (0.95 to 1.97) |
| ≥501 | 1.04 (0.81 to 1.34) | 1.18 (0.91 to 1.53) | 1.44 (1.01 to 2.05) | 1.31 (0.87 to 1.96) |
| WHO clinical stage | ||||
| I | 1 | 1 | 1 | 1 |
| II | 0.86 (0.69 to 1.08) | 0.96 (0.75 to 1.22) | 1.30 (0.96 to 1.76) | 1.16 (0.84 to 1.59) |
| III/IV | 1.34 (1.07 to 1.70) | 1.41 (1.05 to 1.90) | 1.39 (1.04 to 1.85) | 1.07 (0.74 to 1.54) |
| Tuberculosis | ||||
| No | 1 | 1 | 1 | 1 |
| Yes | 0.91 (0.65 to 1.28) | 0.72 (0.49 to 1.04) | 1.01 (0.67 to 1.52) | 0.68 (0.43 to 1.08) |
| BMI, kg/m2 | ||||
| <18.5 | 1.34 (0.98 to 1.85) | 1.31 (0.93 to 1.84) | 2.42 (1.72 to 3.41) | 2.21 (1.52 to 3.21) |
| 18.5 to 24.9 | 1 | 1 | 1 | 1 |
| ≥25 | 0.84 (0.70 to 1.01) | 0.87 (0.72 to 1.07) | 0.91 (0.72 to 1.16) | 0.89 (0.68 to 1.16) |
| Haemoglobin, g/dL | ||||
| ≤9 | 1.65 (1.34 to 2.03) | 1.32 (1.06 to 1.65) | 1.81 (1.38 to 2.39) | 1.39 (1.02 to 1.90) |
| ≥10 | 1 | 1 | 1 | 1 |
| ALT, U/L | ||||
| ≤42 | 1 | 1 | 1 | 1 |
| ≥43 | 0.84 (0.62 to 1.13) | 0.86 (0.63 to 1.17) | 0.78 (0.51 to 1.20) | 0.81 (0.51 to 1.30) |
| Creatinine, µmol/L | ||||
| ≤120 | 1 | 1 | 1 | 1 |
| ≥121 | 1.65 (0.99 to 2.75) | 1.73 (1.00 to 2.99) | 1.67 (0.81 to 3.42) | 1.95 (0.91 to 4.17) |
| NRTI | ||||
| TDF | 1 | 1 | 1 | 1 |
| AZT | 0.64 (0.24 to 1.71) | 0.67 (0.17 to 2.66) | 1.24 (0.82 to 1.86) | 1.23 (0.64 to 2.38) |
| ABC | 3.10 (1.00 to 9.65) | 2.96 (0.89 to 9.91) | 1.34 (0.50 to 3.60) | 1.06 (0.38 to 2.96) |
| NNRTI | ||||
| EFV | 1 | 1 | 1 | 1 |
| NVP | 0.63 (0.23 to 1.68) | 0.66 (0.17 to 2.58) | 1.12 (0.75 to 1.66) | 1.13 (0.61 to 2.11) |
| Phone availability | ||||
| No | 1 | 1 | 1 | 1 |
| Yes | 0.89 (0.69 to 1.15) | 0.80 (0.61 to 1.06) | 1.06 (0.69 to 1.62) | 1.09 (0.70 to 1.70) |
ABC, abacavir; aHR, adjusted hazard ratio; ALT, alanine aminotransferase; AZT, zidovudine; BMI, body mass index; CI, confidence interval; EFV, efavirenz; HR, hazard ratio; NNRTI, non‐nucleoside reverse transcriptase inhibitors; NRTI, nucleoside reverse transcriptase inhibitor; NVP, nevirapine; PHC, primary healthcare level; SHC, secondary healthcare level; SOC, standard of care; TDF, tenofovir disoproxil fumarate; WHO, World Health Organization.
This is the time from HIV diagnosis to ART initiation;
specifications of the flexible parametric models: Treat‐All: three main internal knots and two internal knots for the time‐varying covariate (time since HIV care enrolment). SOC: three main internal knots and one internal knot for the time‐varying covariate (CD4 cell count);
period‐1 is the WHO 2010 (from October 2014 to October 2015) and period‐2 is the WHO 2013 (from November 2015 onwards) ART initiation guideline implementation period as followed under standard of care;
secondary healthcare: ART outpatient departments in one health centre (with inpatient capacity) in Treat‐All and ART outpatient departments in one hospital in standard of care;
this is the time from facility‐based HIV care enrolment to ART initiation.