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Abstract The Tibetan Plateau contains the largest numbers of glaciers outside the polar regions, yet the initiation times of glacial advances remain unclear. The potential relics of original moraines might be preserved in the sedimentary basins. Here, we present sedimentological and geochronological data from five boreholes located upstream of the Tsangpo Gorge, Eastern Himalayan Syntaxis. Our findings reveal that fluvial sediment accumulation began over 2.5 million of years ago due to enhanced rock uplift downstream, and extensive glacial advances occurred after ~0.75 million of years. Notably, the earliest extensive glacial advance (~0.75 million of years) is considerably younger than the formation of the Tsangpo Gorge (>2.5 million of years). Following the initiation of this glacial advance, the Eastern Himalayan Syntaxis experienced rapid exhumation of approximately 1.3–1.6 kilometers. Such geomorphological processes and exhumation history suggest that rock uplift, rather than glacial damming, played a pivotal role in maintaining the stability of the knickpoints on the southeastern margins of the Tibetan Plateau.

Introduction Intimate partner violence (IPV) is a barrier to consistent HIV treatment in South Africa. Previous trials have established that the Common Elements Treatment Approach (CETA), a cognitive-behavioural-based intervention, is effective in reducing mental and behavioural health problems but has not been trialled for effectiveness in improving HIV outcomes. This paper describes the protocol for a randomised trial that is testing the effectiveness of CETA in improving HIV treatment outcomes among women experiencing IPV in South Africa.Methods and analysis We are conducting a randomised trial among HIV-infected women on antiretroviral therapy, who have experienced sexual and/or physical IPV, to test the effect of CETA on increasing retention and viral suppression and reducing IPV. Women living with HIV who have an unsuppressed viral load or are at high risk for poor adherence and report experiencing recent IPV, defined as at least once within in the last 12 months, will be recruited from HIV clinics and randomised 1:1 to receive CETA or an active attention control (text message reminders). All participants will be followed for 24 months. Follow-up HIV data will be collected passively using routinely collected medical records. HIV outcomes will be assessed at 12 and 24 months post-baseline. Questionnaires on violence, substance use and mental health will be administered at baseline, post-CETA completion and at 12 months post-baseline. Our primary outcome is retention and viral suppression (

Introduction: Intermediate care (IC) was redesigned to manage more complex, older patients in the community, avoid admissions and facilitate earlier hospital discharge. The service was ‘enhanced’ by employing GPs, pharmacists and the voluntary sector to be part of a daily interdisciplinary team meeting, working alongside social workers and community staff (the traditional model). Methods: A controlled before-and-after study, using mixed methods and a nested case study. Enhanced IC in one locality (Coastal) is compared with four other localities where IC was not enhanced until the following year (controls), using system-wide performance data (N = 4,048) together withad hocdata collected on referral-type, staff inputs and patient experience (N = 72). Results: Coastal showed statistically significant increase in EIC referrals to 11.6% (95%CI: 10.8%–12.4%), with a growing proportion from GPs (2.9%, 95%CI: 2.5%–3.3%); more people being cared for at home (10.5%, 95%CI: 9.8%–11.2%), shorter episode lengths (9.0 days, CI 95%: 7.6–10.4 days) and lower bed-day rates in ≥70 year-olds (0.17, 95%CI: 0.179–0.161). The nested case study showed medical, pharmacist and voluntary sector input into cases, a more holistic, coordinated service focused on patient priorities and reduced acute hospital admissions (5.5%). Discussion and conclusion: Enhancing IC through greater acute, primary care and voluntary sector integration can lead to more complex, older patients being managed in the community, with modest impacts on service efficiency, system activity, and notional costs off-set by perceived benefits.

Dynamic inhaled gas (3He/129Xe/19F) MRI permits the acquisition of regional fractional-ventilation which is useful for detecting gas-trapping in lung-diseases such as lung fibrosis and COPD. Deninger’s approach used for analyzing the wash-out data can be substituted with the stretched-exponential-model (SEM) because signal-intensity is attenuated as a function of wash-out-breath in 19F lung imaging. Thirteen normal-rats were studied using 3He/129Xe and 19F MRI and the ventilation measurements were performed using two 3T clinical-scanners. Two Cartesian-sampling-schemes (Fast-Gradient-Recalled-Echo/X-Centric) were used to test the proposed method. The fully sampled dynamic wash-out images were retrospectively under-sampled (acceleration-factors (AF) of 10/14) using a varying-sampling-pattern in the wash-out direction. Mean fractional-ventilation maps using Deninger’s and SEM-based approaches were generated. The mean fractional-ventilation-values generated for the fully sampled k-space case using the Deninger method were not significantly different from other fractional-ventilation-values generated for the non-accelerated/accelerated data using both Deninger and SEM methods (p > 0.05 for all cases/gases). We demonstrated the feasibility of the SEM-based approach using retrospective under-sampling, mimicking AF = 10/14 in a small-animal-cohort from the previously reported dynamic-lung studies. A pixel-by-pixel comparison of the Deninger-derived and SEM-derived fractional-ventilation-estimates obtained for AF = 10/14 (≤16% difference) has confirmed that even at AF = 14, the accuracy of the estimates is high enough to consider this method for prospective measurements.

Pervasive low-relief, high-elevation surfaces separated by incised canyons are common across the Southeastern margin of the Tibetan Plateau and have been used to define the nature of crustal deformation that drove plateau growth. A common assumption is that these surfaces were once part of a continuous low-relief paleotopography that has undergone surface uplift and dissection. Recent research, however, has questioned this assumption and the derived geodynamic models, which suggests that these surfaces formed in situ through drainage network reorganization and the piracy of upstream drainage area. Here, we test the continuity of the low-relief surfaces across SE Tibet using a new inversion scheme that also illuminates the nature of conflicting hypotheses. Our analysis is based on combining the local information contained in maps of normalized channel steepness with the more distributed and integrated information contained in maps of normalized landscape response time. This allows us to model the formation of a hypothetical landscape prior to rock uplift and dissection. We find that large variations in channel steepness are required along the trunk channels within the inferred paleotopography. This is inconsistent with a low-relief surface prior to surface uplift and indicates that a surface interpolated between remnants cannot be used to robustly measure geodynamic processes in space and time. Furthermore, our inverse framework highlights many different solutions to this ill-posed problem and thus provides an explanation as to why the topography alone cannot be used to provide a unique solution to the debate.

Objective We used screening data and routine clinic records for intervention arm patients in the Simplified Algorithm for Treatment Eligibility (SLATE) trials to describe the prevalence of tuberculosis (TB) symptoms, diagnosis and treatment among people living with HIV (PLHIV), not on antiretroviral therapy (ART) and presenting at outpatient clinics in South Africa and Kenya. We compared the performance of the WHO four-symptom TB screening tool with a baseline Xpert test.Setting Outpatient HIV clinics in South Africa and Kenya.Participants Eligible patients were non-pregnant, PLHIV, >18 years of age, not on ART, willing to provide written informed consent. A total of 594 patients in South Africa and 240 in Kenya were eligible.Results Prevalence of any TB symptom was 38% in Kenya, 35% (SLATE I) and 47% (SLATE II) in South Africa. During SLATE I, 70% of patients in Kenya and 57% in South Africa with ≥1 TB symptom were tested for TB. In SLATE II, 79% of patients with ≥1 TB symptom were tested. Of those, 19% tested positive for TB in Kenya, 15% (SLATE I) and 5% (SLATE II) tested positive in South Africa. Of the 28 patients who tested positive in both trials, 20 initiated TB treatment. The lowest median CD4 counts were among those with active TB (Kenya 124 cells/mm3; South Africa 193 cells/mm3). When comparing the WHO four-symptom screening tool to the Xpert test (SLATE II), we found that increasing the number of symptoms required for a positive screen from one to three or four decreased sensitivity but increased the positive predictive value to >30%.Conclusions 80% of patients assessed for ART initiation presented with ≥1 TB symptoms. Reconsideration of the ‘any symptom’ rule may be appropriate, with ART initiation among patients with fewer/milder symptoms commencing while TB test results are pending.Trial registration number NCT02891135 and NCT03315013.

Objectives To assess delays to antiretroviral therapy (ART) initiation before and after the Universal Test and Treat (UTT) and the same-day initiation (SDI) of ART policy periods in Johannesburg, South Africa.Design Prospective cohort study.Setting Patients were recruited from six primary health clinics in Johannesburg.Participants Overall, 1029 newly diagnosed HIV positive adults (≥18 years) were consecutively enrolled by referral from the testing counsellor between April and December 2015 (pre-UTT n=146), July and August 2017 (UTT, n=141) and October 2017 and August 2018 (SDI, n=742).Main outcome measures Cox proportional hazards regression was used to assess predictors of 30 days ART initiation. Additionally, predictors of immediate ART initiation were evaluated using Poisson regression.Results Overall, 30 days ART proportions were 71.9% overall, 36.9% pre-UTT (44.3% of those eligible), 65.9% under UTT and 79.9% under the SDI policy. The median days to ART initiation declined from 21 pre-UTT (IQR: 15–30) to 8 (IQR: 6–16) under UTT and 5 days (IQR: 0–8) under the SDI policy. However, only 150 (20.2%) of the SDI cohort-initiated ART immediately after HIV diagnosis. Living in a two-adult home (adjusted HR (aHR) 1.2 vs living alone, 95% CI 1.0 to 1.5) increased the likelihood of 30-day ART. Missing baseline cluster of differentiation four (CD4) data decreased the likelihood of 30 days ART by 40% (aHR 0.6 vs CD4 10 months, 95% CI 0.1 to 0.4).Conclusions The study results highlight a positive move towards earlier ART initiation during the UTT and SDI periods and emphasise a need to increase same-day ART implementation further.

ObjectivesWe extend the method of Significant Zero Crossings of Derivatives (SiZer) to address within-subject correlations of repeatedly collected longitudinal biomarker data and the computational aspects of the methodology when analyzing massive biomarker databases. SiZer is a powerful visualization tool for exploring structures in curves by mapping areas where the first derivative is increasing, decreasing or does not change (plateau) thus exploring changes and normalization of biomarkers in the presence of therapy.MethodsWe propose a penalized spline SiZer (PS-SiZer) which can be expressed as a linear mixed model of the longitudinal biomarker process to account for irregularly collected data and within-subject correlations. Through simulations we show how sensitive PS-SiZer is in detecting existing features in longitudinal data versus existing versions of SiZer. In a real-world data analysis PS-SiZer maps are used to map areas where the first derivative of weight change after antiretroviral therapy (ART) start is significantly increasing, decreasing or does not change, thus exploring the durability of weight increase after the start of therapy. We use weight data repeatedly collected from persons living with HIV initiating ART in five regions in the International Epidemiologic Databases to Evaluate AIDS (IeDEA) worldwide collaboration and compare the durability of weight gain between ART regimens containing and not containing the drug stavudine (d4T), which has been associated with shorter durability of weight gain.ResultsThrough simulations we show that the PS-SiZer is more accurate in detecting relevant features in longitudinal data than existing SiZer variants such as the local linear smoother (LL) SiZer and the SiZer with smoothing splines (SS-SiZer). In the illustration we include data from 185,010 persons living with HIV who started ART with a d4T (53.1%) versus non-d4T (46.9%) containing regimen. The largest difference in durability of weight gain identified by the SiZer maps was observed in Southern Africa where weight gain in patients treated with d4T-containing regimens lasted 59.9 weeks compared to 133.8 weeks for those with non-d4T-containing regimens. In the other regions, persons receiving d4T-containing regimens experienced weight gains lasting 38-62 weeks versus 55-93 weeks in those receiving non-d4T-based regimens.DiscussionPS-SiZer, a SiZer variant, can handle irregularly collected longitudinal data and within-subject correlations and is sensitive in detecting even subtle features in biomarker curves.

Abstract Background Requirements for frequent dispensing of antiretroviral therapy (ART) place demands on health systems and can lead to suboptimal adherence and disengagement in care for patients due to the time and cost of frequent clinic visits. Rigorous data are needed to define optimal ART dispensing strategies and to evaluate the impact of a longer medication supply on retention and virologic suppression and determine whether this strategy lowers costs for both the patient and the health system. To date, no randomized studies have tested the benefits of 6-month dispensing of ART compared to 3-month and standard of care approaches. Methods This study will be an unblinded cluster-randomized, matched controlled trial conducted among 8200 stable, HIV-infected individuals age 18 years and older on ART in Malawi and Zambia, to compare three ART dispensing intervals on the outcomes of retention in care (primary outcome), virologic suppression, and cost-effectiveness. Thirty clusters will be matched according to country, facility type, and ART cohort size and randomized to one of three study arms: standard of care, 3-month dispensing, and 6-month dispensing. Study participants will be followed, and outcomes will be measured at 12, 24, and 36 months. A subset of participants (n = 240) and providers (n = 180) will also participate in qualitative interviews to evaluate feasibility and acceptability of different ART dispensing intervals. Discussion This study will be the first to compare 6-month and 3-month ART dispensing intervals for stable, HIV-infected individuals in Malawi and Zambia. We focus on outcomes relevant to country programs, including retention, virologic suppression, and cost-effectiveness. Results from the study will help resource-limited health systems better understand the full scope of outcomes resulting from various ART dispensing intervals and help to inform health policy decisions. Trial Registration ClinicalTrials.gov, NCT03101592 . Registered on 18 March 2017. Pan African Clinical Trials, PACTR201706002336105 . Registered on 2 June 2017.

Background: Experience and evidence from the Integrated Care Organisation (ICO) in Torbay and South Devon, UK show that implementation of fully integrated systems (comprising acute, community, primary, social, and voluntary services) require, amongst others, leadership and a co-produced engagement approach to foster a shared culture. Aims and Objectives: This is an interactive workshop to explore with participants through plenary and small group, flipcharts, and a prioritisation exercise relevant elements of the ‘Context and Capabilities for Integrated Care’ (CCIC) implementation framework for integration. The outcome is to identify with participants the elements which are most salient and critical (both as facilitator and barriers), how they interact with key processes and outcomes of system transformation, and to discuss emerging best practice and potential solutions. Format (timing, speakers, discussion, group work, etc): The workshop is facilitated by key leaders, representative of the wider system: Dawn Butler - Deputy Director of Strategy, Performance and Planning, Torbay and South Devon NHS Foundation Trust [TSDFT]; Dr Matthew Fox –GP, Locality Clinical Director TSDFT, Governing Body Locality GP (Coastal) South Devon and Torbay Clinical Commissioning Group [CCG], Chloe Myers - Manager, Volunteering In Health @ Coastal Information Centre. Researchers-in-Residence Dr Felix Gradinger, and Dr Julian Elston (University of Plymouth). If participants are consenting to do so, researchers would aim to capture and record the content of the workshop for co-production of research, learning and dissemination. Timing: 90minutes required 10mins: Introductions, co-production aim, overview Clarify and manage expectations, consent 25mins Introducing speakers and 5mins pitch each, RIRs to introduce CCIC framework and relevant domains; Brainstorming exercise (depending on numbers split into 3 or 4 groups each allocated to key elements), Showcase Torbay story; Highlight leadership domains/approaches and interdependence at system level, explain method and highlighted main elements 5mins Individual exercise, prioritising and thinking of examples for key elements; think about how most important elements link to others in the framework in own context; Get people to think about examples from their own practice 25mins Collectively rank around table/group and make links to other elements, consider solutions of how challenges were overcome; and discuss examples for feedback to the plenary (using flip charts); Get people to share why and how links start emerging; reach consensus around feedback from group and prepare to share in plenary 20mins Plenary and live feedback populating domains on whiteboard tying up most important connections and solutions; Start making connections between key elements across domains, formulate best practice elements 5mins End; summary and next steps; Encourage people to think about how to apply this personally or through conference networks Target audience: Managers, Practitioners, Researchers, and Public Representatives. Learnings/Take away: To illustrate system transformation, leadership and approach To introduce an implementation framework for integrated working Prioritise and identify key elements relevant to attendants Share and note experiences of how elements play out Identify solutions (facilitators and barriers) Record and feedback notes from workshop (co-produced leagacy)

Introduction: International policy is encouraging a re-design of health and social care services, including the use of social prescribing. Torbay and South Devon NHS Foundation Trust, an Integrated Care Organisation in the UK, commissioned a voluntary sector ‘Wellbeing Coordination’ service as a key element of the wider care model. This case study seeks to understand how primary, acute, social, community and voluntary services are working together in a locality hub and the impact of wellbeing coordinators on service users’ well-being, use and cost of health and social care services Methods: A before-and-after study, supplemented with qualitative case studies, practitioner interviews/surveys, observations of multidisciplinary team (MDT) meetings and service user/caregiver interactions. Applying an action-based participatory approach, findings were co-produced with stakeholders and members of the public by embedded researchers-in-residence. Quantitative service user data were collected on health and social well-being outcomes and frailty on referral and 12 weeks. Comprehensive activity and cost data were collected at 12 months pre- and post-referral. Results: Health outcomes and service activity data were collected on 49 participants receiving the wellbeing coordination programme. All person-reported outcomes showed statistically significant increases in mean change scores (Warwick-Edinburgh Mental Well-being Scale, Well-being Star™, Patient Activation Measure, Rockwood Clinical Frailty Scale, Living well goals met). Qualitative case studies and observations highlighted key mechanisms of the intervention and the hub working. The impact on health and social care use and cost was more nuanced, with mean activity and cost increasing overall. Referrals from the Enhanced Intermediate Care MDTs (20/49) showed higher levels of use and cost. At locality hub level, the practitioner survey, observations and interview findings show an increase in vertical and horizontal organisational integration and high levels of staff-reported person-centeredness while embodying a strengths-based approach. Discussion: The study shows a positive impact on outcomes and mixed patterns regarding activity and cost. The findings indicate potential for more ‘down-stream’ and preventative work. The close links with the wider voluntary sector add to the hub offer in holding more complexity, providing access and continuity of care, and delivering holistic and personalised care in the right place and at the right time. Conclusion: Key elements of how the hub works indicate the importance of leadership, co-ordination, communication, colocation, and contracting that allows the nourishing of trusting relationships and crossing of organisational and professional boundaries. Lessons learned: Challenges included pooling resources, record sharing, information governance and engaging all stakeholders in a shared vision for a strengths-based, person-centred culture. Ownership and bottom up dynamics and formal and informal relationships between practitioners at all levels, including the community they work with, were key features for overcoming these. Limitations: Case studies and participatory research approaches may be considered lesser to experimental study designs. However, context is crucial to integrated care and extrapolating generalizable findings. Co-production and triangulating varying data sources helps studying and implementing complex system wide transformation. Suggestions for future research: The Researcher-in-Residence model could be rolled out across systems to facilitate learning, and to increase robustness of insights.

Introduction: Torbay and South Devon NHS Foundation Trust, an Integrated Care Organisation, re-designed its Intermediate Care (IC) service to manage more complex, older patients in the community and facilitate earlier hospital discharge and reduce admissions from the community. The “Enhanced” IC service (EIC) employed GPs, pharmacists and the voluntary sector to work with social and community services (the traditional model) in locality ‘hubs’. It was assumed that EIC would deliver a more strengths-based, person-centred, coordinated care (PCCC) ‘closer to home’, whilst reducing system demand and costs. Methods: A mixed-methods case study, using embedded Researchers-in-Residence (RiR), compared the first established service (Coastal EIC) with four other localities, over time (natural experiment). Quantitative data: service input data (n=72); two ad-hoc validated surveys (n=672 and n=17) of PCCC in staff and patients; assessment of service use prevented (n=1001), including a ‘cost-offset’ analysis, calculating ‘notional’ annualised cost-saving; and routine data used to calculate rates in over 70 year-olds for referrals (acute and GP), bed-capacity, admissions and length of stay (LOS). Findings were co-produced with stakeholders to drive change and to explore explanations for differences in outcomes. Results: Service data showed GPs inputted into 36% of cases (not including GP contacts), pharmacists 15% and the voluntary sector 13%. Moderately high need service users reported fairly high levels of PCCC, with an average score of 66%. The PCCC practitioner survey (response rate 39%) showed higher levels of PCCC in 19/27 questions, compared to an Australian benchmark. PCCC was strongest in the domains of ‘treating people holistically’, ‘supporting activation’, ‘feeling joined-up’ and ‘involving the family’. ‘Care planning’, ‘single point of contact’ and ‘telling your story once’ required improvement. EIC prevented 1,940 incidences of service use (1.9 per referral). Most of this fell outside the ICO (Out of Hour GP and nursing services (45.1%), a GP telephone consultation (13.6%), Residential nursing (4.0%) and social services (3.2%)). Prevention of ICO service use equated to 2-3% of emergency attendances. The notional average cost saving was £149.17 per person, mostly due to secondary care avoided. Coastal EIC had persistently shorter LOS, lower bed-day and emergency attendance rates and more care at home than other localities, but fluctuations over time weaken attribution solely to EIC. Discussion: Coastal EIC was managing more complex patients in the community. Greater clinical and pharmaceutical input and personal information at the daily MDT, record sharing and pro-active links with GPs and the hospital, enabled more PCCC, impacting on LOS and demand. Conclusion: EIC has the potential to deliver better patient experience for complex, older patients, whilst reducing demand and costs. Lessons learned: Implementing EIC consistently across localities presented challenges for leadership, GP engagement, record sharing, and links with community and acute services. RiRs can help facilitate relationships, learning and service development. Limitations: Implementing complex integrated interventions often precludes rigorous study designs. Although case studies and participatory research are prone to bias, they can provide rich insights and support change. Suggestions for future research: How can the RiR model support implementation of other complex integrated care initiatives?

Thermochronometry is widely used to track exhumation, the motion of rock towards Earth’s surface, and to gain fresh insights into geodynamic and geomorphic processes. Applications require models to reconstruct a rock’s cooling history as it is exhumed from higher temperatures at depth within the crust to cooler shallower levels and eventually Earth’s surface. Thermochronometric models are dependent on the predictable accumulation and the temperature-dependent loss of radiogenic daughter products measured in the laboratory. However, there are many geologically reasonable scenarios that will yield very similar thermochronometric ages. This similarity hinders finding the actual scenario, so instead an approximate model is sought. Finding suitable model parameters is a potentially ill-posed inverse problem that requires making decisions about how best to extract information from the data and how to combine data to leverage redundant information and reduce the impact of data noise. Often these decisions lead to differences in conclusions of studies and such discrepancies have led to heated debates. Here, we discuss debates centred on the use of a variety of modelling approaches and potential sources of biases that lead to differences in the predicted exhumation rate. We also provide some suggestions about future research paths that will help resolve these debates.

Marine protected areas (MPAs) form the cornerstone of marine conservation. Identifying which factors contribute to their success or failure is crucial considering the international conservation targets for 2020 and the limited funds generally available for marine conservation. We identified common factors of success and/or failure of MPA effectiveness using peer-reviewed publications and first-hand expert knowledge for 27 case studies around the world. We found that stakeholder engagement was considered to be the most important factor affecting MPA success, and equally, its absence, was the most important factor influencing failure. Conversely, while some factors were identified as critical for success, their absence was not considered a driver of failure, and vice versa. This mismatch provided the impetus for considering these factors more critically. Bearing in mind that most MPAs have multiple objectives, including non-biological, this highlights the need for the development and adoption of standardized effectiveness metrics, besides biological considerations, to measure factors contributing to the success or failure of MPAs to reach their objectives. Considering our conclusions, we suggest the development of specific protocols for the assessment of stakeholder engagement, the role of leadership, the capacity of enforcement and compliance with MPAs objectives. Moreover, factors defining the success and failure of MPAs should be assessed not only by technical experts and the relevant authorities, but also by other stakeholder groups whose compliance is critical for the successful functioning of an MPA. These factors should be considered along with appropriate ecological, social, and economic data and then incorporated into adaptive management to improve MPA effectiveness.

High early mortality in patients with HIV-1 starting antiretroviral therapy (ART) in sub-Saharan Africa, compared to Europe and North America, is well documented. Longer-term comparisons between settings have been limited by poor ascertainment of mortality in high burden African settings. This study aimed to compare mortality up to four years on ART between South Africa, Europe, and North America.Data from four South African cohorts in which patients lost to follow-up (LTF) could be linked to the national population register to determine vital status were combined with data from Europe and North America. Cumulative mortality, crude and adjusted (for characteristics at ART initiation) mortality rate ratios (relative to South Africa), and predicted mortality rates were described by region at 0-3, 3-6, 6-12, 12-24, and 24-48 months on ART for the period 2001-2010. Of the adults included (30,467 [South Africa], 29,727 [Europe], and 7,160 [North America]), 20,306 (67%), 9,961 (34%), and 824 (12%) were women. Patients began treatment with markedly more advanced disease in South Africa (median CD4 count 102, 213, and 172 cells/µl in South Africa, Europe, and North America, respectively). High early mortality after starting ART in South Africa occurred mainly in patients starting ART with CD4 count

While CD4 strongly predicts mortality on antiretroviral therapy (ART), estimates from programmatic data suffer from incomplete patient outcomes.We conducted a pooled analysis of one-year mortality data on ART accounting for lost patients. We identified articles reporting one-year mortality by ART initiation CD4 count. We estimated the average mortality among those lost as the value that maximizes the fit of a regression of the natural log of mortality on the natural log of the imputed mean CD4 count in each band.We found 20 studies representing 64,426 subjects and 51 CD4 observations. Without correcting for losses, one-year mortality was >4.8% for all CD4 counts 500 had a one-year mortality

Although the medical outcomes of antiretroviral therapy (ART) for HIV/AIDS are well described, less is known about how ART affects patients' economic activities and quality of life, especially after the first year on ART. We assessed symptom prevalence, general health, ability to perform normal activities, and employment status among adult antiretroviral therapy patients in South Africa over three full years following ART initiation.A cohort of 855 adult pre-ART patients and patients on ART for