Effectiveness of a multivitamin supplementation program among HIV-infected adults in Tanzania
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Author
Sudfeld, Christopher R.
Ulenga, Nzovu
Mtisi, Expeditho
Muya, Aisa N.
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https://doi.org/10.1097/qad.0000000000002033Metadata
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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.Abstract
AbstractObjective: 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.
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