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Malawi Medical Journal
College of Medicine, University of Malawi and Medical Association of Malawi
ISSN: 1995-7262
Vol. 22, No. 2, 2010, pp. 49-56
Bioline Code: mm10014
Full paper language: English
Document type: Research Article
Document available free of charge

Malawi Medical Journal, Vol. 22, No. 2, 2010, pp. 49-56

 en Gender differences in retention and survival on antiretroviral therapy of HIV-1 infected adults in Malawi
Taylor-Smith, Katie; Tweya, Hannock; Harries, Anthony; Schoutene, Erik & Jahn, Andreas


Background There is currently a dearth of knowledge on gender differences in mortality among patients on ART in Africa.
Methods Using data from the national ART monitoring and evaluation system, a survival analysis of all healthcare workers, teachers, and police/army personnel who accessed ART in Malawi by June, September and December 2006 respectively, was undertaken. Gender differences in survival were analysed using Kaplan-Meier estimates and rate ratios were derived from Poisson regression adjusting for confounding.
Results 4670 ART patients (49.8% female) were followed up for a median of 8.7 months after starting ART. Probability of death was significantly higher for men than women (p<0.001). Controlling for age, WHO clinical stage and occupation, men experienced nearly 2 times the mortality of women RR 1.90 [95% CI: 1.57- 2.29]. A higher proportion of men initiated ART in WHO stage 4 (p<0.001).
Conclusion Among healthcare workers, teachers, police/army personnel, men have higher mortality on ART than women. Possible reasons are unclear but could be biological or because men present for ART at a later clinical stage or have poorer adherence to therapy. Improving early access to ART may reduce mortality, especially among men. A gender difference in adherence to therapy needs further investigation.

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