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Gender influence on utilisation and outcomes of HIV/AIDS care and therapy at two national teaching hospitals in Uganda, 2007
Presented by Gideon Amanyire, Uganda.
Amanyire G.1, Mwesigire D.2, Okiror D.3, Mayanja B.4, Muyindike W.5, Ouma J.6, Elyanu P.7, Wanyenze R.8, Kamya M.9, Sewankambo N.S.10
1Makerere University and Mulago Hospital Complex, Administration and Mnagement, Mbarara, Uganda, 2Makerere University and Mulago Hospital Complex, Clinical Services, Kampala, Uganda, 3Makerere University and Mulago Hospital Complex, Clinical Services, Mbarara, Uganda, 4Mbarara University Teaching Hospital, Department of Medicine, Mbarara, Uganda, 5Mbarara University Teaching Hospital, Medical Department, Mbarara, Uganda, 6Makerere University and Mulago Hospital Complex, Statistics, Kampala, Uganda, 7Makerere University and Mulago Hospital Complex, Statistics, Mbarara, Uganda, 8Makerere University and Mulago Hospital Complex, Administration and Management, Kampala, Uganda, 9Mulago - Mbarara Teaching Hospitals Joint AIDS Program (MJAP), Medical Department, Kampala, Uganda, 10Makerere University and Mulago Hospital Complex, Medical Department, Kampala, Uganda
Objectives: In Uganda, the national HIV seroprevalence is 6.4% (2004- 2005 sero-behavioural survey). Among the 15-59 years old, women have a higher prevalence (7.3%) than men (5.2%). We tested the hypothesis that there are no differences by gender in utilisation and outcomes for patients attending HIV/AIDS services.
Methods: Established in November 2004 using a PEPFAR grant, Mulago - Mbarara Teaching Hospitals’ Joint AIDS Program (MJAP) runs eight HIV/AIDS clinics. By January 2007, the program had enrolled 20,774 and initiated 7,463 naïve patients on ARVs. We analysed routinely collected patient data. The topics studied included desegregation by gender on cumulative enrolment, WHO staging, CD4 cell count, follow up, development of TB, mortality and survival rates. We analysed data using Epi Info.
Results: The median age of the patients was 31 years (IQR=26-38). Males constituted 30%. When WHO staging at intake was dichotomised as 1 and 2 to mean early and 3 and 4 to mean late presentations, males were twice as likely to report late, OR=2.1 (95% CI=1.91-2.38). Men’s median CD4 count at intake was 74.5/mm3 (IQR 23-143) compared to 82/mm3 (IQR 30-153) for women. Men were almost twice as likely to suffer from TB, OR=1.9 (95% CI=1.37-2.65). The loss to follow up rate per 1000 person years was 211.1 for men compared 169.6 for women. The mortality rate per 1000 person years was 56.3 for men compared to 51.5 for women.
Conclusions: Fewer men than women are enrolling at our clinics. Compared to women, men are presenting during late stages of the disease, have a higher likelihood of developing TB, higher loss to follow up and mortality rates. These findings indicate that there are gender related imbalances in utilisation of our services and their outcomes, in favour of women. We recommend that gender propagated behaviours and their impact be studied and integrated in HIV/AIDS programming.
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