< Back to previous page

Project

Modeling CD4 count of HIV/AIDS patients' before and after the initiation of Antiretroviral therapy (ART) in Amhara Region, Northwest Ethiopia. (R-4576)

Introducing antiretroviral therapy (ART) has averted 2.5 million deaths in low- and middle-income countries globally since 1995. Sub-Saharan Africa accounts for the vast majority of the averted deaths: about 1.8 million. More than 8 million people had access to antiretroviral therapy in 2011 in low and middle-income countries which indicate 20% increase from 2010. In Ethiopia the cumulative number of patients who have ever started treatment became 268, 934, and 246,347 are currently taking the treatment, consisting of 76.6% coverage of the estimated total number of HIV positive patients that require the ART treatment. Amhara Region is the first of highly affected regions by HIV/AIDS in Ethiopia in which the average prevalence was 2.7% (9.9% urban and 1.5 rural). From the total HIV positive population only 63147 were getting access for ART in this region. The criteria to start ART treatment consider CD4 cell count, viral load, WHO clinical stage, presence of co-infection and total lymphocyte Count. Treatment should be initiated in all patients with CD4 counts of less than 350/mm3 regardless of symptoms. The basic principle of antiretroviral therapy is immune restoration by achieving a maximal recovery of CD4 cells with permanent and sustained virologic suppression, reduction in hospitalization rates, opportunistic infections, and deaths associated with HIV infection. The project aims to model the CD4 count and survival of HIV/AIDS patients who are currently on ART treatment in to examine the rate of HIV progression. Survival analysis will be used to identify correlates of death of HIV/AIDS patients after they start of ART drug. Moreover, semi-parametric mixed effect model and Bayesian approach will be used to model the CD4 count with the other explanatory variables available in the record. Joint modeling will be employed to model the survival status and the trend of CD4 count of the patients. The methodology developed will be applied to the cohort of HIV/AIDS patients who are on follow up at the ART clinics in Amhara region, Ethiopia. There were a total of 10,862 patients who visited ART clinic since the start of the program. Among these 7,334 are ever started ART while 3528 are on pre-ART follow-up. A total of 971 patients started ART since 2009 and are age greater than 14 and has at least two CD4 count measurements. The variables included are gender, age, encounter date, ART start date, appointment date, functional status, WHO stage, base and follow-up CD4 cell count, original regimen and follow-up regimen. A follow-up CD4 cell count was performed at 3 and 6 month intervals, respectively. The study is approved by the research and community service core process of the University of Gondar. A permission letter is obtained from the medical director of the hospital.
Date:1 Sep 2013 →  30 Jun 2016
Keywords:CLINICAL TRIALS, EPIDEMIOLOGY AND PUBLIC HEALTH
Disciplines:Scientific computing, Bioinformatics and computational biology, Public health care, Public health sciences, Public health services