Published 17 February 2009, doi:10.1136/bmj.b201
Cite this as: BMJ 2009;338:b201

Research

Combination antiretroviral therapy in population affected by conflict: outcomes from large cohort in northern Uganda

¹ The AIDS Support Organization (TASO), Kampala, Uganda, ² TASO, Gulu, Uganda, ³ British Columbia Centre for Excellence in HIV/AIDS, Vancouver, Canada, ⁴ Division of Infectious Diseases, Ottawa Hospital, Ottawa, Canada

Objective To measure the clinical and immunological outcomes of HIV positive adult patients receiving combination antiretroviral therapy in conflict affected northern Uganda.

Design Prospective cohort study.

Setting Gulu District, northern Uganda.

Participants 1625 adults (aged over 14 years) receiving combination antiretroviral therapy.

Main outcome measures Primary outcome: all cause mortality. Secondary outcomes: impact of covariates (sex, age, CD4 count at start, adherence, tuberculosis at start, duration of treatment, and internally displaced person status) on mortality.

Results Sixty nine (4.2%) patients died during follow-up. The mortality incidence rate was 3.48 (95% confidence interval 2.66 to 4.31) per 100 person years. Patients started treatment with a median CD4 count of 157 (interquartile range 90-220) cells/µl; most (1009; 63%) had World Health Organization stage 2 defined illness. Sixty two patients had pulmonary tuberculosis at the start of treatment. Of the 1521 patients with adherence data, 118 (7.8%) had adherence of less than 95% and 1403 (92.2%) had adherence of 95% or above.

Conclusion Patients receiving combination antiretroviral therapy in conflict affected northern Uganda had a mortality comparable to that of patients in peaceful, low income settings and better adherence than patients in higher income settings. These favourable findings highlight the need to expand access to combination antiretroviral therapy in populations affected by armed conflict.

© Kiboneka et al 2009
This is an open-access article distributed under the terms of the Creative Commons Attribution Non-commercial License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

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Related external webpages:

Listen to an interview with lead author Ed Mills about the work of TASO in northern Uganda.

This article has been cited by other articles:

• Jacob, S. T, Abongomera, G. (2009). Adherence to combination antiretroviral therapy in complex emergency settings. BMJ 338: a2662-a2662 [Full text]  

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