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A decade of HIV care in rural Tanzania: Trends in clinical outcomes and impact of clinic optimisation in an open, prospective cohort
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OBJECTIVES: Our objectives were to describe trends in enrolment
and clinical outcomes in the open, prospective Kilombero and
Ulanga Antiretroviral Cohort (KIULARCO) in the Morogoro region
of southern Tanzania, and identify strengths and areas for
improvement in the care of HIV-positive individuals in rural
Tanzania. METHODS: We included adults (>/=15 years) and
children (<15 years) enrolled in the cohort in 2005-2014. The
cohort underwent significant changes from autumn 2012 to
optimise care. We evaluated mortality and loss to follow-up
(LTFU) using competing risks methods, ART usage, opportunistic
infections (OI), co-infections and laboratory abnormalities.
RESULTS: Overall, 7010 adults and 680 children were enrolled;
enrolment peaked in 2008 but has increased steadily since 2011.
Among adults (65% female; median age 37 [interquartile range
31-45] years), the proportion referred from hospital wards
quadrupled in 2013-14 versus earlier years. 653 (9%) adults died
and 2648 (38%) were LTFU; the five-year cumulative probabilities
of death and LTFU were 10.3% and 44.0%, respectively. Among
children, 69 (10%) died and 225 (33%) were LTFU. The
corresponding five-year probabilities were 12.1% and 39.6%.
Adult ART use (regardless of eligibility) increased from 5% in
2005 to 89% in 2014 (similarly among children), with 9% on
second-line therapy in 2014 (17% of children). OI diagnoses
increased over time; tuberculosis prevalence at enrolment
quadrupled from 6% in 2011 to 26% in 2014. The proportion of
newly-enrolled participants assessed for laboratory
abnormalities peaked at nearly 100% in 2014 (from a minimum of
24%), yet abnormality prevalences remained fairly constant.
CONCLUSIONS: In this cohort, ART usage improved dramatically and
is approaching targets of 90%. Improved screening led to
increases in detection of OIs and laboratory abnormalities,
suggesting that a large number of these co-morbidities
previously went undetected and untreated. Further work will
address the high LTFU rates and implications for mortality
estimates, and the management and outcomes of co-morbidities.
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VANOBBERGHEN, Fiona, et al. A decade of HIV care in rural Tanzania: Trends in clinical
outcomes and impact of clinic optimisation in an open,
prospective cohort. PloS one. 2017. Vol. 12, num. 7, pags. e0180983. ISSN 1932-6203. [consulted: 19 of August of 2026]. Available at: https://hdl.handle.net/2445/115796