Outcomes for people living with HIV treated through the Thai National AIDS Program: 2008 – 2014

Abstract

The past two decades have seen increasing number of patients with HIV accessing treatment in resource limited settings. This has resulted in a better prognosis and increased life expectancy of HIV-infected individuals. This thesis aims to 1) quantify the estimated life expectancy of HIV-infected patients among different income regions, and 2) investigate programmatic and patient outcomes of patients treated under the Universal coverage program (UC) in Thailand.Meta-analytic techniques were used to assess life expectancy across high and low/middle-income countries. This thesis also assesses outcomes of the UC between 2008 and 2014, when the database was linked with National Death Registry. Life expectancy was estimated using the abridged-life table method. Survival analysis techniques were used to estimate lost to follow-up and mortality rates in adults, and attrition and treatment outcomes in children who started first-line antiretroviral therapy (ART). Life expectancy after starting ART differs markedly between high and low/middle-income regions. The life expectancy between sex is similar in high-income countries, but in low/middle income countries women had better life-expectancy than men. This pattern of better life expectancy in women was also found in the Thai UC system. In addition, life expectancy of Thai HIV-infected people has improved over time, and with increasing CD4 cell count at ART initiation. Loss to follow-up was higher prior to ART compared to after starting ART, but the rates were modest compared to cohorts in sub-Saharan Africa. Patients who are young and healthy had the highest risk of LTFU, especially adolescents. Children aged <12 years starting first-line ART were more likely to achieve immunological recovery compared to children ≥12 years, many of whom switched to second-line ART within 6 months after detectable viral load failure.Scaling-up of ART has substantially increased the life expectancy of patients starting ART between different income regions globally, and more specifically within the Thai UC system. These results demonstrate that the Thai UC, with integrated provision of treatment and care services for people living with HIV, is effective in terms of programmatic and patient outcomes, and could provide a model for service and care delivery in other resource-limited countries