A national survey of the impact of rapid scale-up of antiretroviral therapy on health-care workers in Malawi: effects on human resources and survival
Simon D Makombe, Andreas Jahn, Hannock Tweya, Stuart Chuka, Joseph Kwong-Leung Yu, Mindy Hochgesang, John Aberle-Grasse, Olesi Pasulani, Erik J Schouten, Kelita Kamoto, Anthony D Harries
Volume 85, Number 11, November 2007, 851-857
Table 3. Mortality rates and cumulative 12-month survival probabilities for health-care workers on ART and projected survival based on mortality rates from a natural history cohort in Malawi from the era before free ART13
| Health-care worker cohort on ART |
Malawi natural history cohort |
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|---|---|---|---|---|---|---|---|---|---|---|---|
| WHOclinicalstage | n | MR/100 pyrsa (95% CI) | 12-month survival |
MR/100 pyrsa (95% CI) | MRR d | 12-month survival |
|||||
| Survivalprobabilityb | No.alivec | Survivalprobabilityb | No.alivec | ||||||||
| 1 or 2 | 176 | 8 | (5–13) | 92% | 162 | 5 | (2–12) | 1.6 | 95% | 167 | |
| 3 | 580 | 19 | (15–23) | 83% | 480 | 62 | (42–86) | 0.3 | 54% | 312 | |
| 4 | 265 | 26 | (20–34) | 77% | 204 | 88 | (35–180) | 0.3 | 41% | 110 | |
| Total | 1 021 | – | – | – | 846 | – | – | – | – | 589 | |
ART, antiretroviral therapy; CI, confidence interval; MR, mortality rate; MRR, mortality rate ratio; pyrs, person-years.a Failure events (deaths, treatment stops and clinic defaults) per 100 person-years of observation. Follow-up studies in Malawi have shown that the majority of ART clinic defaulters are unrecognized deaths (unpublished data). In the natural history cohort, failure events are actual deaths only.b Cumulative probability of survival at 12 months after ART initiation. For the natural history cohort, the estimate is based on e(-MR*1) of the 1-year mortality rates quoted in the study, assuming an approximately constant mortality rate over the first 12 months. To improve comparability, the same method was used for the health-care worker cohort (the actual cumulative survival probabilities based on the Kaplan–Meier method were 89%, 82% and 77%, respectively).c Projection of the number of health-care workers alive by 12 months after ART initiation, estimated as the number of individuals in each clinical stage category multiplied by the respective survival probability.d MRR = MR of health-care worker on ART / MR of natural history cohort.