Outcomes for people living with HIV treated through the Thai National AIDS Program: 2008 – 2014

The past two decades have seen increasing number of patients with HIV accessing treatment in resource limited settings. This has resulted in a better prognosis and increased life expectancy of HIV-infected individuals. This thesis aims to 1) quantify the estimated life expectancy of HIV-infected patients among different income regions, and 2) investigate programmatic and patient outcomes of patients treated under the Universal coverage program (UC) in Thailand.Meta-analytic techniques were used to assess life expectancy across high and low/middle-income countries. This thesis also assesses outcomes of the UC between 2008 and 2014, when the database was linked with National Death Registry. Life expectancy was estimated using the abridged-life table method. Survival analysis techniques were used to estimate lost to follow-up and mortality rates in adults, and attrition and treatment outcomes in children who started first-line antiretroviral therapy (ART). Life expectancy after starting ART differs markedly between high and low/middle-income regions. The life expectancy between sex is similar in high-income countries, but in low/middle income countries women had better life-expectancy than men. This pattern of better life expectancy in women was also found in the Thai UC system. In addition, life expectancy of Thai HIV-infected people has improved over time, and with increasing CD4 cell count at ART initiation. Loss to follow-up was higher prior to ART compared to after starting ART, but the rates were modest compared to cohorts in sub-Saharan Africa. Patients who are young and healthy had the highest risk of LTFU, especially adolescents. Children aged