Evaluation of a workplace HIV treatment programme in South Africa
ABSTRACT To review the experience of implementing a workplace HIV care programme in South Africa and describe treatment outcomes in sequential cohorts of individuals starting antiretroviral therapy (ART).
A review of an industrial HIV care and treatment programme. Between October 2002 and December 2005, 2262 patients enrolled in the HIV care programme.
CD4 cell counts increased by a median of 90, 113 and 164 cells/microl by 6, 12 and 24 months on treatment, respectively. The viral load was suppressed below 400 copies/ml in 75, 72 and 72% of patients at 6, 12 and 24 months, respectively, at an average cost of US$1654, 3567 and 7883 per patient virally suppressed, respectively. Treatment outcomes in sequential cohorts of patients were consistent over time. A total of 93.6% of patients at 14,752 clinic visits reported missing no tablets over the previous 3 days. Almost half the patients (46.8%) experienced one or more adverse events, although most were mild (78.7%). By the end of December 2005, 30% of patients were no longer on ART, mostly because of defaulted or stopped treatment (12.8%), termination of employment (8.2%), or death (4.9%).
This large workplace programme achieved virological results among individuals retained in the programme comparable to those reported for developed countries; more work is needed to improve retention. Monitoring treatment outcomes in sequential cohorts is a useful way of monitoring programme performance. As the programme has matured, the costs of programme implementation have reduced. Counselling is a central component of an ART programme. Challenges in implementing a workplace ART programme are similar to the challenges of public-sector programmes.
- SourceAvailable from: Morten Skovdal
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- "Properly administered ART can extend the healthy life span of workers by ten years or more (Walensky et al., 2009). Research from South Africa has shown that workplace ART provision can achieve HIV viral suppression comparable to levels reported in developed countries (Charalambous et al., 2007). Rosen et al. (2008) found that pre-ART workers were almost twice as likely to report being unable to work in the previous fiveday work week than those who had recently begun ART. "
ABSTRACT: Purpose – The purpose of the paper is to provide recommendations for medium-and large-sized workplaces on how to support HIV-positive employees. Supporting HIV-positive workers is an issue of social responsibility and an economic necessity for employers. HIV-positive workers can remain productive and healthy for many years if able to access appropriate HIV management support. Design/methodology/approach – Recent (2000-2010) academic and grey literature on HIV workplace management was reviewed and a qualitative study of nine workers receiving antiretroviral treatment (ART) in Zimbabwe was conducted by the authors. Results from both the literature review and qualitative study were used to develop recommendations. Findings – Carefully considered organizational support is of primary importance in the following areas: workplace HIV policy, voluntary testing and counselling, HIV management, HIV treatment uptake and adherence, day-to-day assistance, peer education, nutrition support, opportunistic infection (OI) monitoring and support to temporary/contract workers. Confidentiality is a key element in achieving positive outcomes in all areas of organizational support for HIV-positive workers. Practical implications – The paper provides a source of information and concrete advice for workplaces seeking to implement or augment HIV management and support services for their employees. The paper offers vital insight into workplace intervention strategies shown work best for workplaces and employees. Originality/value – The paper fills a need for comprehensive documentation of strategies for effective HIV management at medium-and large-sized workplaces. Introduction and overview Over 22 million people in sub-Saharan Africa are HIV positive (UNAIDS/WHO, 2009). More than 90 per cent of HIV-positive people are adults in the prime of their lives (ILO, 2008). In 2008 the adult (15-49 years) prevalence rate across sub-Saharan Africa was 5.2 per cent (UNAIDS/WHO, 2009) with markedly higher rates in certain countries andInternational Journal of Workplace Health Management 09/2013; 6(3):174-188. DOI:10.1108/IJWHM-12-2010-0043
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ABSTRACT: To investigate attitudes to directly observed antiretroviral therapy (DOT ART) among HIV infected adults attending a workplace HIV care programme in South Africa. Clients attending workplace HIV clinics in two regions were interviewed using a semi-structured questionnaire. 100 individuals (99% male, mean age 40.2 years) participated, 61% were already taking ART by self administration. 71% had previous tuberculosis (TB) with the majority having received DOT for TB. 65% of individuals indicated that they would not like to receive ART by DOT-the main reason given was a desire to take responsibility for their own treatment. This contrasted with 79% who thought TB treatment by DOT a good idea. On questioning about disclosure, 70% reported disclosure to their sexual partners and 21% to fellow workers. 78% of individuals indicated willingness to support someone else taking ART. ART by DOT was not an immediately popular concept with our patients, primarily because of a desire to retain responsibility for their own treatment. More work is needed to understand what key elements of treatment support are needed to promote adherence.Sexually Transmitted Infections 09/2007; 83(5):383-6. DOI:10.1136/sti.2007.025585 · 3.08 Impact Factor
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ABSTRACT: Long-term retention of patients in Africa's rapidly expanding antiretroviral therapy (ART) programs for HIV/AIDS is essential for these programs' success but has received relatively little attention. In this paper we present a systematic review of patient retention in ART programs in sub-Saharan Africa. We searched Medline, other literature databases, conference abstracts, publications archives, and the "gray literature" (project reports available online) between 2000 and 2007 for reports on the proportion of adult patients retained (i.e., remaining in care and on ART) after 6 mo or longer in sub-Saharan African, non-research ART programs, with and without donor support. Estimated retention rates at 6, 12, and 24 mo were calculated and plotted for each program. Retention was also estimated using Kaplan-Meier curves. In sensitivity analyses we considered best-case, worst-case, and midpoint scenarios for retention at 2 y; the best-case scenario assumed no further attrition beyond that reported, while the worst-case scenario assumed that attrition would continue in a linear fashion. We reviewed 32 publications reporting on 33 patient cohorts (74,192 patients, 13 countries). For all studies, the weighted average follow-up period reported was 9.9 mo, after which 77.5% of patients were retained. Loss to follow-up and death accounted for 56% and 40% of attrition, respectively. Weighted mean retention rates as reported were 79.1%, 75.0% and 61.6 % at 6, 12, and 24 mo, respectively. Of those reporting 24 mo of follow-up, the best program retained 85% of patients and the worst retained 46%. Attrition was higher in studies with shorter reporting periods, leading to monthly weighted mean attrition rates of 3.3%/mo, 1.9%/mo, and 1.6%/month for studies reporting to 6, 12, and 24 months, respectively, and suggesting that overall patient retention may be overestimated in the published reports. In sensitivity analyses, estimated retention rates ranged from 24% in the worse case to 77% in the best case at the end of 2 y, with a plausible midpoint scenario of 50%. Since the inception of large-scale ART access early in this decade, ART programs in Africa have retained about 60% of their patients at the end of 2 y. Loss to follow-up is the major cause of attrition, followed by death. Better patient tracing procedures, better understanding of loss to follow-up, and earlier initiation of ART to reduce mortality are needed if retention is to be improved. Retention varies widely across programs, and programs that have achieved higher retention rates can serve as models for future improvements.PLoS Medicine 11/2007; 4(10):e298. DOI:10.1371/journal.pmed.0040298 · 14.00 Impact Factor