Skip to main content
bioRxiv
  • Home
  • About
  • Submit
  • ALERTS / RSS
Advanced Search
New Results

What drives mortality among HIV patients in a conflict setting? A prospective cohort study in the Central African Republic

View ORCID ProfileThomas Crellen, Charles Ssonko, Turid Piening, Marcel Mbeko Simaleko, Diemer Henri St. Calvaire, Karen Gieger, M. Ruby Siddiqui
doi: https://doi.org/10.1101/437103
Thomas Crellen
1Médecins Sans Frontières Hollande, Avenue Barthelemy Boganda, PK4, Bangui, BP 1793, Central African Republic
2Mahidol-Oxford Tropical Medicine Research Unit, 420/6 Rajvithi Road, Tungphyathai, Bangkok 10400, Thailand
  • Find this author on Google Scholar
  • Find this author on PubMed
  • Search for this author on this site
  • ORCID record for Thomas Crellen
  • For correspondence: tomcrellen@gmail.com
Charles Ssonko
3Médecins Sans Frontières, The Manson Unit, Chancery Exchange, 10 Furnival Street, London, EC4A 1AB, United Kingdom
  • Find this author on Google Scholar
  • Find this author on PubMed
  • Search for this author on this site
Turid Piening
5Médecins Sans Frontières, Am Köllnischen Park 1, 10179 Berlin, Germany
  • Find this author on Google Scholar
  • Find this author on PubMed
  • Search for this author on this site
Marcel Mbeko Simaleko
4Ministre de la Santé Publique et de la Population, Bangui, BP 883, Central African Republic
  • Find this author on Google Scholar
  • Find this author on PubMed
  • Search for this author on this site
Diemer Henri St. Calvaire
4Ministre de la Santé Publique et de la Population, Bangui, BP 883, Central African Republic
  • Find this author on Google Scholar
  • Find this author on PubMed
  • Search for this author on this site
Karen Gieger
1Médecins Sans Frontières Hollande, Avenue Barthelemy Boganda, PK4, Bangui, BP 1793, Central African Republic
  • Find this author on Google Scholar
  • Find this author on PubMed
  • Search for this author on this site
M. Ruby Siddiqui
3Médecins Sans Frontières, The Manson Unit, Chancery Exchange, 10 Furnival Street, London, EC4A 1AB, United Kingdom
  • Find this author on Google Scholar
  • Find this author on PubMed
  • Search for this author on this site
  • Abstract
  • Full Text
  • Info/History
  • Metrics
  • Preview PDF
Loading

Abstract

Background Provision of antiretroviral therapy (ART) during conflict settings is rarely attempted and little is known about the expected patterns of mortality. The Central African Republic (CAR) continues to have a low coverage of ART despite an estimated 120,000 people living with HIV and 11,000 AIDS-related deaths in 2013. We present results from a cohort in Zemio, Haut-Mboumou prefecture. This region had the highest prevalence of HIV nationally (14.8% in 2010) and was subject to repeated attacks by armed groups on civilians during the observed period.

Methods Conflict from armed groups can impact cohort mortality rates i) directly if HIV patients are victims of armed conflict, or ii) indirectly if population displacement or fear of movement reduces access to ART. Using monthly counts of civilian deaths, injuries and abductions, we estimated the impact of the conflict on patient mortality. We also determine patient-level risk factors for mortality and how this varies with time spent in the cohort. Model-fitting was performed in a Bayesian framework, using generalised-linear models with terms accounting for temporal autocorrelation.

Results Patients were recruited and observed from October 2011 to May 2017. Overall 1631 patients were enrolled, giving 4107 person-years and 148 deaths. Our first model shows that patient mortality did not increase during periods of heightened conflict. The monthly risk (probability) of mortality was markedly higher at the beginning of the program (0.047 in November 2011 [95% credible interval; CrI 0.0078, 0.21]) and had declined greater than ten-fold by the end of the observed period (0.0016 in June 2017 [95% CrI 0.00042, 0.0036]). Our second model shows the risk of mortality for individual patients was highest in the first five months spent in the cohort. Male sex was associated with a higher mortality (odds ratio; OR 1.7 [95% CrI 1.2, 2.8]) along with the severity of opportunistic infections at baseline.

Conclusions Our results show that chronic conflict did not appear to adversely affect rates of mortality in this cohort, and that mortality was driven predominantly by patient specific risk factors. In areas initiating ART for the first time, particular attention should be focussed on stabilising patients with advanced symptoms.

Funding Médecins Sans Frontières

Copyright 
The copyright holder for this preprint is the author/funder, who has granted bioRxiv a license to display the preprint in perpetuity. It is made available under a CC-BY-NC 4.0 International license.
Back to top
PreviousNext
Posted October 11, 2018.
Download PDF
Email

Thank you for your interest in spreading the word about bioRxiv.

NOTE: Your email address is requested solely to identify you as the sender of this article.

Enter multiple addresses on separate lines or separate them with commas.
What drives mortality among HIV patients in a conflict setting? A prospective cohort study in the Central African Republic
(Your Name) has forwarded a page to you from bioRxiv
(Your Name) thought you would like to see this page from the bioRxiv website.
CAPTCHA
This question is for testing whether or not you are a human visitor and to prevent automated spam submissions.
Share
What drives mortality among HIV patients in a conflict setting? A prospective cohort study in the Central African Republic
Thomas Crellen, Charles Ssonko, Turid Piening, Marcel Mbeko Simaleko, Diemer Henri St. Calvaire, Karen Gieger, M. Ruby Siddiqui
bioRxiv 437103; doi: https://doi.org/10.1101/437103
Digg logo Reddit logo Twitter logo CiteULike logo Facebook logo Google logo Mendeley logo
Citation Tools
What drives mortality among HIV patients in a conflict setting? A prospective cohort study in the Central African Republic
Thomas Crellen, Charles Ssonko, Turid Piening, Marcel Mbeko Simaleko, Diemer Henri St. Calvaire, Karen Gieger, M. Ruby Siddiqui
bioRxiv 437103; doi: https://doi.org/10.1101/437103

Citation Manager Formats

  • BibTeX
  • Bookends
  • EasyBib
  • EndNote (tagged)
  • EndNote 8 (xml)
  • Medlars
  • Mendeley
  • Papers
  • RefWorks Tagged
  • Ref Manager
  • RIS
  • Zotero
  • Tweet Widget
  • Facebook Like
  • Google Plus One

Subject Area

  • Epidemiology
Subject Areas
All Articles
  • Animal Behavior and Cognition (2653)
  • Biochemistry (5286)
  • Bioengineering (3696)
  • Bioinformatics (15824)
  • Biophysics (7279)
  • Cancer Biology (5633)
  • Cell Biology (8118)
  • Clinical Trials (138)
  • Developmental Biology (4782)
  • Ecology (7548)
  • Epidemiology (2059)
  • Evolutionary Biology (10604)
  • Genetics (7746)
  • Genomics (10163)
  • Immunology (5223)
  • Microbiology (13962)
  • Molecular Biology (5399)
  • Neuroscience (30878)
  • Paleontology (217)
  • Pathology (883)
  • Pharmacology and Toxicology (1527)
  • Physiology (2262)
  • Plant Biology (5035)
  • Scientific Communication and Education (1045)
  • Synthetic Biology (1399)
  • Systems Biology (4156)
  • Zoology (814)