Persistent High Burden and Mortality Associated With Advanced HIV Disease in Rural Tanzania Despite Uptake of World Health Organization "Test and Treat" Guidelines

Linda Stöger; Andrew Katende; Herry Mapesi; Aneth V Kalinjuma; Liselot van Essen; Thomas Klimkait; Manuel Battegay; Maja Weisser; Emilio Letang

doi:10.1093/ofid/ofac611

Persistent High Burden and Mortality Associated With Advanced HIV Disease in Rural Tanzania Despite Uptake of World Health Organization "Test and Treat" Guidelines

Open Forum Infect Dis. 2022 Dec 16;9(12):ofac611. doi: 10.1093/ofid/ofac611. eCollection 2022 Dec.

Authors

Linda Stöger¹, Andrew Katende², Herry Mapesi^{2

3

4}, Aneth V Kalinjuma^{2

5}, Liselot van Essen⁶, Thomas Klimkait³, Manuel Battegay^{3

7}, Maja Weisser^{2

3

4

7}, Emilio Letang¹

Affiliations

¹ ISGlobal, Hospital Clinic, Universitat de Barcelona, Barcelona, Spain.
² Ifakara Health Institute, Ifakara, Tanzania.
³ Department Biomedicine-Petersplatz, University of Basel, Basel, Switzerland.
⁴ Swiss Tropical and Public Health Institute, Basel, Switzerland.
⁵ Faculty of Health Sciences, Department of Epidemiology and Biostatistics, University of the Witwatersrand, School of Public Health, Johannesburg, South Africa.
⁶ Gerion, Amsterdam University Medical Center, Amsterdam, The Netherlands.
⁷ Division of Infectious Diseases and Hospital Epidemiology, University Hospital Basel, Basel, Switzerland.

Abstract

Background: Information about burden, characteristics, predictors, and outcomes of advanced human immunodeficiency virus disease (AHD) is scarce in rural settings of sub-Saharan Africa. Human immunodeficiency virus (HIV) infections and associated deaths remain high despite specific guidelines issued by the World Health Organization (WHO).

Methods: Burden of AHD and 6-month death/loss to follow-up (LTFU) were described among 2498 antiretroviral therapy (ART)-naive nonpregnant people with HIV (PWH) aged >15 years enrolled in the Kilombero Ulanga Antiretroviral Cohort in rural Tanzania between 2013 and 2019. Baseline characteristics associated with AHD and predictors of death/LTFU among those with AHD were analyzed using multivariate logistic and Cox regression, respectively.

Results: Of the PWH, 62.2% had AHD at diagnosis (66.8% before vs 55.7% after national uptake of WHO "test and treat" guidelines in 2016). At baseline, older age, male sex, lower body mass index, elevated aminotransferase aspartate levels, severe anemia, tachycardia, decreased glomerular filtration rate, clinical complaints, impaired functional status, and enrollment into care before 2018 were independently associated with AHD. Among people with AHD, incidence of mortality, and LTFU were 16 and 34 per 100 person-years, respectively. WHO clinical stage 3 or 4, CD4 counts <100 cells/µL, severe anemia, tachypnea, and liver disease were associated with death/LTFU.

Conclusions: More than 50% of PWH enrolled in our cohort after test and treat implementation still had AHD at diagnosis. Increasing HIV testing and uptake and implementation of the WHO-specific guidelines on AHD for prevention, diagnosis, treatment of opportunistic infections, and reducing the risks of LTFU are urgently needed to reduce morbidity and mortality.

Keywords: advanced HIV disease; death and loss to follow-up; opportunistic infections; sub-Saharan Africa; test and treat.