{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,23]],"date-time":"2026-09-23T04:40:35Z","timestamp":1790138435900,"version":"4.0.1"},"reference-count":27,"publisher":"Wiley","issue":"7","license":[{"start":{"date-parts":[[2015,4,2]],"date-time":"2015-04-02T00:00:00Z","timestamp":1427932800000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/100009054","name":"PEPFAR","doi-asserted-by":"crossref","id":[{"id":"10.13039\/100009054","id-type":"DOI","asserted-by":"crossref"}]},{"DOI":"10.13039\/100004417","name":"Global Fund","doi-asserted-by":"crossref","id":[{"id":"10.13039\/100004417","id-type":"DOI","asserted-by":"crossref"}]},{"name":"NACP, as part of the Tanzania Ministry of Health and Social Welfare"},{"name":"MRC"},{"name":"DFID"},{"DOI":"10.13039\/100000865","name":"Bill & Melinda Gates Foundation","doi-asserted-by":"crossref","id":[{"id":"10.13039\/100000865","id-type":"DOI","asserted-by":"crossref"}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Tropical Med Int Health"],"published-print":{"date-parts":[[2015,7]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec><jats:title>Objectives<\/jats:title><jats:p>Rates of first\u2010line treatment failure and switches to second\u2010line therapy are key indicators for national <jats:styled-content style=\"fixed-case\">HIV<\/jats:styled-content> programmes. We assessed immunological treatment failure defined by <jats:styled-content style=\"fixed-case\">WHO<\/jats:styled-content> criteria in the Tanzanian national <jats:styled-content style=\"fixed-case\">HIV<\/jats:styled-content> programme.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>We included adults initiating first\u2010line therapy in 2004\u20132011 with a pre\u2010treatment <jats:styled-content style=\"fixed-case\">CD<\/jats:styled-content>4 count, and \u22656\u2010months of follow\u2010up. We assessed subhazard ratios (SHR) for immunological treatment failure, and subsequent switch to second\u2010line therapy, using competing risks methods to account for deaths.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>Of 121\u00a0308 adults, 7% experienced immunological treatment failure, and 2% died without observed immunological treatment failure, over a median 1.7\u00a0years. The 6\u2010year cumulative probability of immunological treatment failure was 19.0% (95% <jats:styled-content style=\"fixed-case\">CI<\/jats:styled-content> 18.5, 19.7) and of death, 5.1% (4.8, 5.4). Immunological treatment failure predictors included earlier year of treatment initiation (<jats:italic>P\u00a0<\/jats:italic>&lt;\u00a00.001), initiation in lower level facilities (<jats:styled-content style=\"fixed-case\">SHR<\/jats:styled-content>\u00a0=\u00a02.23 [2.03, 2.45] for dispensaries <jats:italic>vs<\/jats:italic>. hospitals), being male (1.27 [1.19, 1.33]) and initiation at low or high <jats:styled-content style=\"fixed-case\">CD<\/jats:styled-content>4 counts (for example, 1.78 [1.65, 1.92] and 5.33 [4.65, 6.10] for &lt;50 and \u2265500 <jats:italic>vs<\/jats:italic>. 200\u2013349 cells\/mm<jats:sup>3<\/jats:sup>, respectively). Of 7382 participants in the time\u2010to\u2010switch analysis, 6% switched and 5% died before switching. Four years after immunological treatment failure, the cumulative probability of switching was 7.3% (6.6, 8.0) and of death, 6.8% (6.0, 7.6). Those who immunologically failed in dispensaries, health centres and government facilities were least likely to switch.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p>Immunological treatment failure rates and unmet need for second\u2010line therapy are high in Tanzania; virological monitoring, at least for persons with immunological treatment failure, is required to minimise unnecessary switches to second\u2010line therapy. Lower level government health facilities need more support to reduce treatment failure rates and improve second\u2010line therapy uptake to sustain the benefits of increased coverage.<\/jats:p><\/jats:sec>","DOI":"10.1111\/tmi.12507","type":"journal-article","created":{"date-parts":[[2015,3,17]],"date-time":"2015-03-17T01:32:59Z","timestamp":1426555979000},"page":"880-892","source":"Crossref","is-referenced-by-count":22,"title":["Immunological failure of first\u2010line and switch to second\u2010line antiretroviral therapy among <scp>HIV<\/scp>\u2010infected persons in <scp>T<\/scp>anzania: analysis of routinely collected national data"],"prefix":"10.1111","volume":"20","author":[{"given":"Fiona M.","family":"Vanobberghen","sequence":"first","affiliation":[{"name":"London School of Hygiene &amp; Tropical Medicine London UK"},{"name":"Mwanza Intervention Trials Unit National Institute for Medical Research Mwanza Tanzania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Bonita","family":"Kilama","sequence":"additional","affiliation":[{"name":"National AIDS Control Program Dar es Salaam Tanzania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Alison","family":"Wringe","sequence":"additional","affiliation":[{"name":"London School of Hygiene &amp; Tropical Medicine London UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Angela","family":"Ramadhani","sequence":"additional","affiliation":[{"name":"National AIDS Control Program Dar es Salaam Tanzania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Basia","family":"Zaba","sequence":"additional","affiliation":[{"name":"London School of Hygiene &amp; Tropical Medicine London UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Donan","family":"Mmbando","sequence":"additional","affiliation":[{"name":"Ministry of Health and Social Welfare Dar es Salaam Tanzania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jim","family":"Todd","sequence":"additional","affiliation":[{"name":"London School of Hygiene &amp; Tropical Medicine London UK"},{"name":"Kilimanjaro Christian Medical University College Moshi Tanzania"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2015,4,2]]},"reference":[{"key":"e_1_2_6_2_1","unstructured":"WHO.15 facts on HIV treatment scale\u2010up and new WHO ARV guidelines [Internet] 2013. 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