Outcomes after two years of providing antiretroviral treatment in Khayelitsha, South Africa.

Hdl Handle:
http://hdl.handle.net/10144/38956
Title:
Outcomes after two years of providing antiretroviral treatment in Khayelitsha, South Africa.
Authors:
Coetzee, D; Hildebrand, K; Boulle, A; Maartens, G; Louis, F; Labatala, V; Reuter, H; Ntwana, N; Goemaere, E
Journal:
AIDS (London, England)
Abstract:
BACKGROUND: A community-based antiretroviral therapy (ART) programme was established in 2001 in a South African township to explore the operational issues involved in providing ART in the public sector in resource-limited settings and demonstrate the feasibility of such a service. METHODS: Data was analysed on a cohort of patients with symptomatic HIV disease and a CD4 lymphocyte count < 200 x 10 cells/l. The programme used standardized protocols (using generic medicines whenever possible), a team-approach to clinical care and a patient-centred approach to promote adherence. RESULTS: Two-hundred and eighty-seven adults naive to prior ART were followed for a median duration of 13.9 months. The median CD4 lymphocyte count was 43 x 10 cells/l at initiation of treatment, and the mean log10 HIV RNA was 5.18 copies/ml. The HIV RNA level was undetectable (< 400 copies/ml) in 88.1, 89.2, 84.2, 75.0 and 69.7% of patients at 3, 6, 12, 18 and 24 months respectively. The cumulative probability of remaining alive was 86.3% at 24 months on treatment for all patients, 91.4% for those with a baseline CD4 lymphocyte count > or =50 x 10 cells/l, and 81.8% for those with a baseline CD4 lymphocyte count < 50 x 10 cells/l. The cumulative probability of changing a single antiretroviral drug by 24 months was 15.1% due to adverse events or contraindications, and 8.4% due to adverse events alone. CONCLUSIONS: ART can be provided in resource-limited settings with good patient retention and clinical outcomes. With responsible implementation, ART is a key component of a comprehensive response to the epidemic in those communities most affected by HIV.
Affiliation:
Infectious Disease Epidemiology Unit, School of Public Health and Family Medicine, University of Cape Town, Anzio Road, Observatory 7925, South Africa.
Issue Date:
9-Apr-2004
URI:
http://hdl.handle.net/10144/38956
PubMed ID:
15060436
Language:
en
ISSN:
0269-9370
Appears in Collections:
HIV/AIDS

Full metadata record

DC FieldValue Language
dc.contributor.authorCoetzee, D-
dc.contributor.authorHildebrand, K-
dc.contributor.authorBoulle, A-
dc.contributor.authorMaartens, G-
dc.contributor.authorLouis, F-
dc.contributor.authorLabatala, V-
dc.contributor.authorReuter, H-
dc.contributor.authorNtwana, N-
dc.contributor.authorGoemaere, E-
dc.date.accessioned2008-10-13T15:07:18Z-
dc.date.available2008-10-13T15:07:18Z-
dc.date.issued2004-04-09-
dc.identifier.citationOutcomes after two years of providing antiretroviral treatment in Khayelitsha, South Africa. 2004, 18 (6):887-95 AIDSen
dc.identifier.issn0269-9370-
dc.identifier.pmid15060436-
dc.identifier.urihttp://hdl.handle.net/10144/38956-
dc.description.abstractBACKGROUND: A community-based antiretroviral therapy (ART) programme was established in 2001 in a South African township to explore the operational issues involved in providing ART in the public sector in resource-limited settings and demonstrate the feasibility of such a service. METHODS: Data was analysed on a cohort of patients with symptomatic HIV disease and a CD4 lymphocyte count < 200 x 10 cells/l. The programme used standardized protocols (using generic medicines whenever possible), a team-approach to clinical care and a patient-centred approach to promote adherence. RESULTS: Two-hundred and eighty-seven adults naive to prior ART were followed for a median duration of 13.9 months. The median CD4 lymphocyte count was 43 x 10 cells/l at initiation of treatment, and the mean log10 HIV RNA was 5.18 copies/ml. The HIV RNA level was undetectable (< 400 copies/ml) in 88.1, 89.2, 84.2, 75.0 and 69.7% of patients at 3, 6, 12, 18 and 24 months respectively. The cumulative probability of remaining alive was 86.3% at 24 months on treatment for all patients, 91.4% for those with a baseline CD4 lymphocyte count > or =50 x 10 cells/l, and 81.8% for those with a baseline CD4 lymphocyte count < 50 x 10 cells/l. The cumulative probability of changing a single antiretroviral drug by 24 months was 15.1% due to adverse events or contraindications, and 8.4% due to adverse events alone. CONCLUSIONS: ART can be provided in resource-limited settings with good patient retention and clinical outcomes. With responsible implementation, ART is a key component of a comprehensive response to the epidemic in those communities most affected by HIV.en
dc.language.isoenen
dc.rightsPublished by Wolters Kluwer Lippincott Williams & Wilkins - Archived on this site by kind permission Wolters Kluweren
dc.subject.meshAdulten
dc.subject.meshAnti-HIV Agentsen
dc.subject.meshCommunity Health Servicesen
dc.subject.meshDeveloping Countriesen
dc.subject.meshDrug Costsen
dc.subject.meshFemaleen
dc.subject.meshFollow-Up Studiesen
dc.subject.meshHIV Infectionsen
dc.subject.meshHIV-1en
dc.subject.meshHumansen
dc.subject.meshMaleen
dc.subject.meshSouth Africaen
dc.subject.meshTreatment Outcomeen
dc.subject.meshViral Loaden
dc.titleOutcomes after two years of providing antiretroviral treatment in Khayelitsha, South Africa.en
dc.contributor.departmentInfectious Disease Epidemiology Unit, School of Public Health and Family Medicine, University of Cape Town, Anzio Road, Observatory 7925, South Africa.en
dc.identifier.journalAIDS (London, England)en

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