Survival Outcomes of Vietnamese People with HIV after Initiating Antiretroviral Treatment: Role of Clinic-Related Factor
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ORIGINAL PAPER
Survival Outcomes of Vietnamese People with HIV after Initiating Antiretroviral Treatment: Role of Clinic‑Related Factors Nhien Thi Hoang1 · Nguyen Thao Thi Nguyen2 · Quang Nhat Nguyen3,4 · John W. Bollinger5 · Bach Xuan Tran6,7 · Nhan Thi Do1 · Trang Huyen Thi Nguyen8 · Huong Lan Thi Nguyen3,9 · Trang Ha Nguyen3,9 · Carl A. Latkin7 · Cyrus S. H. Ho10 · Roger C. M. Ho11,12 Accepted: 29 October 2020 © Springer Science+Business Media, LLC, part of Springer Nature 2020
Abstract Given the rapid development of HIV clinics in Vietnam, this study evaluates the infrastructure surrounding this expansion, identifying clinic-related factors that impact survival outcomes. A retrospective longitudinal study was conducted among people living with HIV (PLWH) who initiated antiretroviral therapy (ART) between 2011 and 2015 among 62 ART clinics in 15 provinces. The mortality rate during the 717674.1 person-years of observation (PYO) was 0.29/100 PYO. Location in rural areas (versus urban) and in Central Vietnam (versus Northern Vietnam) were associated with higher risk of mortality. The risk was lower among clinics that had peer-educators. As Vietnam’s HIV/AIDS program continues to expand, this data supports increasing resource allocation for rural clinics, incorporation of ART with the community’s existing healthcare infrastructure in its efforts to decentralize, and integration of services to reflect patients’ anticipated needs. Keywords HIV · ART · Facility · Survival outcome · Vietnam
Introduction Rates of AIDS-related mortality have drastically declined as a result of widely accessible antiretroviral therapy (ART) in low- and middle-income countries (LMIC) [1, 2]. Research has found that the leading cause of death among people living with HIV (PLWH) on ART is opportunistic infections [3], of which tuberculosis, toxoplasmosis, and pneumocystis pneumonia were found to be the leading causes of death [4]. Other studies have identified associations between individual * Huong Lan Thi Nguyen [email protected] 1
Vietnam Authority of HIV/AIDS Control, Hanoi, Vietnam
Duke University School of Medicine, Duke University, Durham, NC, USA
2
factors and early mortality—including age of ART initiation, sex, low baseline CD4, low baseline BMI, and co-infection with TB [4, 5]. Yet, in order to more thoroughly understand factors influencing survival, it is necessary to look beyond patient characteristics towards clinic-related variables. As such, this study examines the role of clinic-related factors on survival outcomes of PLWH on ART. In the past decade, Vietnam has witnessed a 45% decrease in AIDS-related deaths, from 8,500 deaths in 2010 to 4,700 in 2018 [6]. This number is expected to decrease even 7
Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, USA
8
Center of Excellence in Pharmacoeconomics and Management, Nguyen Tat Thanh University, Ho Chi Minh City, Vietnam
9
3
Institute for Global Health Innovations, Duy Tan University, Da Nang, Vietnam
Faculty of
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