Article

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

ABSTRACT

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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    • "A series of errors with the application (no doctor's stamp, a shortage of clinic letterheads, Ophelia's inability to provide a utility bill) prevented it from even being processed despite the fact that she was clearly eligible under all the necessary criteria to receive funds. Her resentment with this situation was such that, at one stage, she was partly monitoring -such as the work of Boulle et al. in Khayelitsha -about 10% have been lost to follow-up and over 14% are on second-line therapy because of adherence issues with their first-line drugs (Boulle et al 2010). The Western Cape in the Republic of South Africa, while a resource-poor setting, is probably the most 'developed' infrastructure for HIV treatment on the continent: it is where most of the assumptions about 'adherence', birthed in the industrial economies of the North (shaky as they may be for marginal populations in those settings) should best work. "

    Full-text · Article · Jan 2015
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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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    ABSTRACT: Background Data on the effectiveness of second-line antiretroviral therapy (ART) in resource-limited countries of Eastern Europe is limited. Objective of this study was to evaluate virological outcomes of second-line ART in Georgia. Methods We conducted retrospective analysis using routinely available program data. Study included adult HIV-infected patients with confirmed HIV drug resistance, who were switched to second-line ART from August 2005 to December 2010. Patients were followed until July 1, 2011. Primary outcome was achievement of viral suppression. Demographic, clinical, laboratory and adherence data were abstracted from medical and program records. Adherence was expressed as percentage based on medication refill data, and was calculated as days supply of medications dispensed divided by days between prescription fills. Predictors of primary outcome were assessed in modified Poisson regression analysis. Results A total of 84 patients were included in the study. Among them 71.4% were men and 62% had history of IDU. All patients were receiving non-nucleoside reverse transcriptase based regimen as initial ART. The mean 6-month adherence prior to virologic failure was 75%, with 31% of patients showing 100% adherence. All patients were switched to protease inhibitor based regimens. Patients were followed for median 27 months. Over this period 9 (10.7%) patients died. Among 80 patients remaining alive at least 6 month after ART regimen switch, 72 (90%) patients ever reached undetectable viral load. The mean first 6-month adherence on second-line treatment was 81%, with 47.5% of patients showing 100% adherence. The proportion of patients achieving viral suppression after 6, 12, 24 and 36 months of second-line ART did not vary significantly ranging from 79 to 83%. Percentage of IDUs achieving viral suppression ranged from 75% and 83%. Factors associated with failure to achieve viral suppression at 6-months of second-line ART were: adherence <80% (Risk ratio [RR] 5.09, 95% CI: 1.89-13.70) and viral load >100,000 at the time of treatment failure (RR 3.39, 95% CI: 1.46-7.89). Conclusions The study demonstrated favourable virological outcomes of the second-line ART in Georgia. Majority of patients, including IDUs, achieved sustained virological response over 36 month period. The findings highlight the need of improving adherence.
    Full-text · Article · Jul 2014 · AIDS Research and Therapy
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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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    ABSTRACT: Background: Voluntary counselling and testing (VCT) together with a safe sexual behaviour is an important preventive strategy in the control of HIV. Although Health care workers (HCWs) are critical in the response to HIV, little is known about VCT and high risk behaviours (HRB) among this group in West Africa. This study aims to assess the prevalence of VCT and HRB among HCWs in Burkina Faso. Methods: We collected data through a questionnaire in urban areas (Ouagadougou and Bobo-Dioulasso) and rural areas (Poni and Yatenga) among HCWs from 97 health care facilities. Urine samples were collected, screened for HIV using a Calypte(®) test kit and confirmed by Western Blot. Multiple logistic regression analysis was performed to identify factors associated with the use of VCT services and with high-risk sex behaviour. Results: About 92.5% of eligible HCWs participated (1570 out of 1697). Overall, 38.2% of them (34.6% of women and 42.6% of men) had ever used VCT services. About 40% of HCWs reported that fear of knowing the test result was the main reason for not doing the HIV test. Male HCWs (p = 0.001), laboratory workers (p < 0.001), those having two years or more experience (p = 0.03), and those who had multiple partners (p = 0.001) were more likely to have tested for HIV. One fifth of HCWs reported multiple partners. Of these, thirteen percent did not use condoms. HCWs who had multiple partners were significantly more likely to be men, single, living in rural areas, and under the age of 29 years. Conclusion: VCT was still very low among HCWs in Burkina Faso, while HRB was high.These findings suggest that 'HCW-friendly' VCT centres should be implemented, securing confidentiality among colleagues. In addition, refreshment courses on HIV risk reduction, counselling and testing are certainly required during the professional career of HCWs.
    Full-text · Article · Jun 2013 · BMC Public Health
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