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.
"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. "
[Show abstract][Hide abstract] 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 and
International Journal of Workplace Health Management 09/2013; 6(3):174-188. DOI:10.1108/IJWHM-12-2010-0043
"We can distinguish two main reasons for losses from our programme; individuals who have left the workforce, which may not relate to virological outcome, and those remaining in the workforce who have stopped ART, who may be assumed to have treatment failure. The reasons for default have been briefly reported elsewhere  and are currently being investigated in detail. From patient interview the reasons cited for leaving the programme included use of traditional medicines, side effects and not being convinced of the benefits of treatment. "
[Show abstract][Hide abstract] ABSTRACT: Reasons for the variation in reported treatment outcomes from antiretroviral therapy (ART) programmes in developing countries are not clearly defined.
Among ART-naïve individuals in a workplace ART programme in South Africa we determined virological outcomes at 12 months, and risk factors for suboptimal virological outcome, defined as plasma HIV-1 viral load > or = 400 copies/ml.
Among 1760 individuals starting ART before July 2004, 1172 were in follow-up at 12 months of whom 953 (81%) had a viral load measurement (median age 41 yrs, 96% male, median baseline CD4 count 156 x 10(6)/l). 71% (681/953) had viral load < 400 copies/ml at 12 months. In a multivariable analysis, independent predictors of suboptimal virological outcome at 12 months were <1 log decrease in viral load at six weeks (odds ratio [OR] 4.71, 95% confidence interval [CI] 2.56-8.68), viral load at baseline (OR 3.63 [95% CI 1.88-7.00] and OR 3.54 [95% CI 1.79-7.00] for 10,001-100,000 and >100,000 compared to < or = 10,000 copies/ml, respectively), adherence at six weeks (OR 3.50 [95% CI 1.92-6.35]), WHO stage (OR 2.08 [95% CI 1.28-3.34] and OR 2.03 [95% CI 1.14-3.62] for stage 3 and 4 compared to stage 1-2, respectively) and site of ART delivery. Site of delivery remained an independent risk factor even after adjustment for individual level factors. At 6 weeks, of 719 patients with self-reported adherence and viral load, 72 (10%) reported 100% adherence but had <1 log decrease in viral load; conversely, 60 (8%) reported <100% adherence but had > or = 1 log decrease in viral load.
Virological response at six weeks after ART start was the strongest predictor of suboptimal virological outcome at 12 months, and may identify individuals who need interventions such as additional adherence support. Self reported adherence was less strongly associated but identified different patients compared with viral load at 6 weeks. Site of delivery had an important influence on virological outcomes; factors at the health system level which influence outcome need further investigation to guide development of effective ART programmes.
[Show abstract][Hide abstract] 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.
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