Seven-year experience of a primary care antiretroviral treatment programme in Khayelitsha, South Africa

School of Public Health and Family Medicine, University of Cape Town, Anzio Road, Cape Town, South Africa.
AIDS (London, England) (Impact Factor: 5.55). 02/2010; 24(4):563-72. DOI: 10.1097/QAD.0b013e328333bfb7
Source: PubMed


We report on outcomes after 7 years of a community-based antiretroviral therapy (ART) programme in Khayelitsha, South Africa, with death registry linkages to correct for mortality under-ascertainment.
This is an observational cohort study.
Since inception, patient-level clinical data have been prospectively captured on-site into an electronic patient information system. Patients with available civil identification numbers who were lost to follow-up were matched with the national death registry to ascertain their vital status. Corrected mortality estimates weighted these patients to represent all patients lost to follow-up. CD4 cell count outcomes were reported conditioned on continuous virological suppression.
Seven thousand, three hundred and twenty-three treatment-naive adults (68% women) started ART between 2001 and 2007, with annual enrolment increasing from 80 in 2001 to 2087 in 2006. Of 9.8% of patients lost to follow-up for at least 6 months, 32.8% had died. Corrected mortality was 20.9% at 5 years (95% confidence interval 17.9-24.3). Mortality fell over time as patients accessed care earlier (median CD4 cell count at enrolment increased from 43 cells/microl in 2001 to 131 cells/microl in 2006). Patients who remained virologically suppressed continued to gain CD4 cells at 5 years (median 22 cells/microl per 6 months). By 5 years, 14.0% of patients had failed virologically and 12.2% had been switched to second-line therapy.
At a time of considerable debate about future global funding of ART programmes in resource-poor settings, this study has demonstrated substantial and durable clinical benefits for those able to access ART throughout this period, in spite of increasing loss to follow-up.

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    • "Recent meta-analysis of 19 studies found that that proportion of patients achieving viral suppression dropped from 78% at 6 months to 62% at 36 months of starting second-line regimen [8]. However, there was substantially heterogeneity between studies, with some studies reporting success rates of around and more than 90% [13-16]. In our study more than 80% of patients consistently had undetectable levels of viral load after 6 months of second-line ART. "
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    AIDS Research and Therapy 07/2014; 11(1):18. DOI:10.1186/1742-6405-11-18 · 1.46 Impact Factor
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    • "Male HCWs were more likely to have been tested for HIV than female HCWs. Data from the demographic and health surveys on prior HIV testing experience, suggest higher testing among females in West African countries, [18,27-29] and in South Africa [30-32]. However, according to the 2005 Ethiopia Demographic Health Survey, 4% of women and 6% of men had ever been tested for HIV [33]. "
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    • "The finding that disengagement from care has increased with each year of programme scale-up is of major concern: individuals enrolled on ART in 2010 and 2011 had more than double the risk of disengagement compared with those enrolled in 2004–2006. This supports findings from other programmes (Boulle et al. 2010; Fatti et al. 2011; Nglazi et al. 2011), although only one had corrected LTF for mortality (Boulle et al. 2010). This may reflect health systems struggling to cope with increasing patient load. "
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