dc.contributor.author | Sudfeld, Christopher R. | |
dc.contributor.author | Buchanan, Ashley | |
dc.contributor.author | Ulenga, Nzovu | |
dc.contributor.author | Spiegelman, Donna | |
dc.contributor.author | Mtisi, Expeditho | |
dc.contributor.author | Hertzmark, Ellen | |
dc.contributor.author | Muya, Aisa N. | |
dc.contributor.author | Sando, David | |
dc.contributor.author | Mungure, Ester | |
dc.contributor.author | Fawzi, Wafaie | |
dc.contributor.author | Mizinduko, Mucho | |
dc.date.accessioned | 2019-01-11T14:19:40Z | |
dc.date.issued | 2018-10 | |
dc.identifier.citation | Sudfeld, Christopher R., Ashley N. Buchanan, Nzovu W. Ulenga, Donna Spiegelman, Expeditho Mtisi, Ellen Hertzmark, Aisa Muya, David Sando, Ester Mungure, Mucho Mizinduko, and Wafaie Fawzi. "Effectiveness of a Multivitamin Supplementation Program among HIV-infected Adults in Tanzania." AIDS 33, no. 1 (2019): 93-100. | en_US |
dc.identifier.issn | 0269-9370 | en_US |
dc.identifier.uri | http://nrs.harvard.edu/urn-3:HUL.InstRepos:37985560 | * |
dc.description.abstract | Abstract
Objective: The objective of this study was to assess the effectiveness of a routine multivitamin supplementation program for adults living with HIV in Tanzania.
Design: We conducted a retrospective cohort study of 67,707 adults enrolled in the Dar es Salaam HIV care and treatment program during 2004-2012.
Methods: The Dar es Salaam HIV care and treatment program intended to provide all adult patients with multivitamin supplements (vitamins B-complex, C, and E) free of charge; however, intermittent stockouts and other implementation issues did not afford universal coverage. We use Cox proportional hazard models to assess the time-varying association of multivitamin supplementation with mortality and clinical outcomes.
Results: The study cohort contributed 41,540 and 129,315 person-years of follow-up time to the ART-naïve and ART-experienced analyses, respectively. Among 48,207 ART-naïve adults, provision of multivitamins reduced the risk of mortality (adjusted hazard ratio (aHR): 0.69; 95% CI: 0.59-0.81), incident tuberculosis (TB) (aHR: 0.83; 0.76-0.91), and meeting ART eligibility criteria (aHR: 0.78; 95% CI: 0.73-0.83) after adjustment for time-varying confounding. Among 46,977 ART-experienced patients, multivitamins reduced mortality (HR: 0.86; 95% CI: 0.80-0.92), incident TB (aHR: 0.78; 95% CI: 0.73-0.84), and immunologic failure (aHR: 0.70; 95% CI: 0.67-0.73). The survival benefits associated with provision multivitamins appeared to be greatest during the first year of ART and declined over time (p-value <0.001).
Conclusion: Multivitamin supplementation appears to be a simple, effective, safe, and scalable program to improve survival, reduce incidence of TB, and improve treatment outcomes for adult HIV patients in Tanzania. | en_US |
dc.language.iso | en_US | en_US |
dc.publisher | Ovid Technologies (Wolters Kluwer Health) | en_US |
dash.license | OAP | |
dc.subject | cohort study | en_US |
dc.subject | HIV | en_US |
dc.subject | implementation science | en_US |
dc.subject | micronutrient | en_US |
dc.subject | nutrition | en_US |
dc.subject | supplement | en_US |
dc.subject | tuberculosis | en_US |
dc.title | Effectiveness of a multivitamin supplementation program among HIV-infected adults in Tanzania | en_US |
dc.type | Journal Article | en_US |
dc.description.version | Accepted Manuscript | en_US |
dc.relation.journal | AIDS | en_US |
dash.depositing.author | Fawzi, Wafaie | |
dc.date.available | 2019-01-11T14:19:40Z | |
dash.affiliation.other | Harvard T.H. Chan School of Public Health | en_US |
dc.identifier.doi | 10.1097/qad.0000000000002033 | |
dc.source.journal | AIDS | |
dash.source.page | 1 | |
dash.contributor.affiliated | Mungure, Ester | |
dash.contributor.affiliated | Buchanan, Ashley | |
dash.contributor.affiliated | Mizinduko, Mucho | |
dash.contributor.affiliated | Sando, David | |
dash.contributor.affiliated | Hertzmark, Ellen | |
dash.contributor.affiliated | Spiegelman, Donna | |
dash.contributor.affiliated | Fawzi, Wafaie | |