# name
A decade of HIV care in rural Tanzania: Trends in clinical
                outcomes and impact of clinic optimisation in an open,
                prospective cohort

# metadata.dc.description.abstract[].value
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.

# metadata.dc.relation.isformatof[].value
Reproducció del document publicat a:
                http://dx.doi.org/10.1371/journal.pone.0180983

# metadata.dc.source[].value
Articles publicats en revistes (ISGlobal)

# metadata.dc.title[].value
A decade of HIV care in rural Tanzania: Trends in clinical
                outcomes and impact of clinic optimisation in an open,
                prospective cohort