aCenter for Global Health and Development, Boston University, Boston, MA, USA bDepartment of Epidemiology, Boston University School of Public Health, Boston, MA, USA cHealth Economics and Epidemiology Research Office, Department of Medicine, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa dDepartment of International Health, Boston University School of Public Health, Boston, MA, USA eRight to Care, Johannesburg, South Africa fClinical HIV Research Unit, Department of Medicine, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa. AIDS (London, England)
(Impact Factor: 5.55).
06/2012; DOI: 10.1097/QAD.0b013e328357058a
OBJECTIVES:: To assess outcomes over the first seven years of antiretroviral therapy at Themba Lethu Clinic, Johannesburg, South Africa. DESIGN:: Observational cohort study. METHODS:: Patients are managed according to South African National Treatment Guidelines. Mortality is ascertained through linkage with the national vital registration system. Loss to follow-up is defined as ≥3 months late for the last scheduled appointment. RESULTS:: Between April 2004 and March 2010, 13,227 patients initiated ART, increasing from 1,794 in the year 2004/5 to 2,481 in 2009/10. Median CD4 at ART initiation increased 39% between 2004 and 2009 (82 vs. 114 cells/mm). The proportion who died within one year on ART was below 11% at all time points, while the proportion lost by one year increased from 8.5% in 2004 to 12.1% in 2009 (RR: 1.42; 95%CI: 1.18-1.71).We followed the 1,794 patients initiated in April 2004-March 2005 through August, 2011 for 8,172 person-years. We estimated 25% of patients were lost and 16% died. The overall mortality rate was 3.59/100 PY (95%CI: 3.20-4.02). Of the 1,577 who completed ≥6 months of follow up, 213 (13.5%) failed first-line treatment in a median (IQR) of 25.9 (15.8-41.4) months on treatment. Of those who failed, 141 (66.2%) switched to second-line for a rate of 48.5/100 PY (95%CI: 41.1-57.2). CONCLUSIONS:: Despite some improvements over seven years, more intervention is needed in the first year on treatment to reduce overall attrition.