Antiretroviral therapy and early mortality in South Africa.

Hdl Handle:
http://hdl.handle.net/10144/38397
Title:
Antiretroviral therapy and early mortality in South Africa.
Authors:
Boulle, A; Bock, P; Osler, M; Cohen, K; Channing, L; Hilderbrand, K; Mothibi, E; Zweigenthal, V; Slingers, N; Cloete, K; Abdullah, F
Journal:
Bulletin of the World Health Organization
Abstract:
OBJECTIVE: To describe province-wide outcomes and temporal trends of the Western Cape Province antiretroviral treatment (ART) programme 5 years since inception, and to demonstrate the utility of the WHO monitoring system for ART. METHODS: The treatment programme started in 2001 through innovator sites. Rapid scaling-up of ART provision began early in 2004, located predominantly in primary-care facilities. Data on patients starting ART were prospectively captured into facility-based registers, from which monthly cross-sectional activity and quarterly cohort reports were aggregated. Retention in care, mortality, loss to follow-up and laboratory outcomes were calculated at 6-monthly durations on ART. FINDINGS: By the end of March 2006, 16 234 patients were in care. The cohort analysis included 12 587 adults and 1709 children. Women accounted for 70% of adults enrolled. After 4 and 3 years on ART respectively, 72.0% of adults (95% confidence interval, CI: 68.0-75.6) and 81.5% (95% CI: 75.7-86.1) of children remained in care. The percentage of adults starting ART with CD4 counts less than 50 cells/microl fell from 51.3% in 2001 to 21.5% in 2005, while mortality at 6 months fell from 12.7% to 6.6%, offset in part by an increase in loss to follow-up (reaching 4.7% at 6 months in 2005). Over 85% of adults tested had viral loads below 400 copies/ml at 6-monthly durations until 4 years on ART. CONCLUSION: The location of care in primary-care sites in this programme was associated with good retention in care, while the scaling-up of ART provision was associated with reduced early mortality.
Affiliation:
School of Public Health and Family Medicine, University of Cape Town, Cape Town, South Africa. andrew.boulle@uct.ac.za
Publisher:
Wolrd Health Organization
Issue Date:
Sep-2008
URI:
http://hdl.handle.net/10144/38397
PubMed ID:
18797643
Language:
en
ISSN:
0042-9686
Appears in Collections:
HIV/AIDS

Full metadata record

DC FieldValue Language
dc.contributor.authorBoulle, A-
dc.contributor.authorBock, P-
dc.contributor.authorOsler, M-
dc.contributor.authorCohen, K-
dc.contributor.authorChanning, L-
dc.contributor.authorHilderbrand, K-
dc.contributor.authorMothibi, E-
dc.contributor.authorZweigenthal, V-
dc.contributor.authorSlingers, N-
dc.contributor.authorCloete, K-
dc.contributor.authorAbdullah, F-
dc.date.accessioned2008-10-01T14:11:30Z-
dc.date.available2008-10-01T14:11:30Z-
dc.date.issued2008-09-
dc.identifier.citationAntiretroviral therapy and early mortality in South Africa. 2008, 86 (9):678-87 Bull. World Health Organ.en
dc.identifier.issn0042-9686-
dc.identifier.pmid18797643-
dc.identifier.urihttp://hdl.handle.net/10144/38397-
dc.description.abstractOBJECTIVE: To describe province-wide outcomes and temporal trends of the Western Cape Province antiretroviral treatment (ART) programme 5 years since inception, and to demonstrate the utility of the WHO monitoring system for ART. METHODS: The treatment programme started in 2001 through innovator sites. Rapid scaling-up of ART provision began early in 2004, located predominantly in primary-care facilities. Data on patients starting ART were prospectively captured into facility-based registers, from which monthly cross-sectional activity and quarterly cohort reports were aggregated. Retention in care, mortality, loss to follow-up and laboratory outcomes were calculated at 6-monthly durations on ART. FINDINGS: By the end of March 2006, 16 234 patients were in care. The cohort analysis included 12 587 adults and 1709 children. Women accounted for 70% of adults enrolled. After 4 and 3 years on ART respectively, 72.0% of adults (95% confidence interval, CI: 68.0-75.6) and 81.5% (95% CI: 75.7-86.1) of children remained in care. The percentage of adults starting ART with CD4 counts less than 50 cells/microl fell from 51.3% in 2001 to 21.5% in 2005, while mortality at 6 months fell from 12.7% to 6.6%, offset in part by an increase in loss to follow-up (reaching 4.7% at 6 months in 2005). Over 85% of adults tested had viral loads below 400 copies/ml at 6-monthly durations until 4 years on ART. CONCLUSION: The location of care in primary-care sites in this programme was associated with good retention in care, while the scaling-up of ART provision was associated with reduced early mortality.en
dc.language.isoenen
dc.publisherWolrd Health Organizationen
dc.rightsArchived with thanks to Bulletin of the World Health Organizationen
dc.titleAntiretroviral therapy and early mortality in South Africa.en
dc.contributor.departmentSchool of Public Health and Family Medicine, University of Cape Town, Cape Town, South Africa. andrew.boulle@uct.ac.zaen
dc.identifier.journalBulletin of the World Health Organizationen

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