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Title: Seven-year experience of a primary care antiretroviral treatment programme in Khayelitsha, South Africa.
Authors: Boulle, Andrew
Van Cutsem, Gilles
Hilderbrand, Katherine
Cragg, Carol
Abrahams, Musaed
Mathee, Shaheed
Ford, Nathan
Knight, Louise
Osler, Meg
Myers, Jonny
Goemaere, Eric
Coetzee, David
Maartens, Gary
Affiliation: School of Public Health and Family Medicine, University of Cape Town, Anzio Road, Cape Town, South Africa. andrew.boulle@uct.ac.za
Citation: Seven-year experience of a primary care antiretroviral treatment programme in Khayelitsha, South Africa. 2010, 24 (4):563-72 AIDS
Journal: AIDS (London, England)
Issue Date: 20-Feb-2010
URI: http://hdl.handle.net/10144/95573
DOI: 10.1097/QAD.0b013e328333bfb7
PubMed ID: 20057311
Abstract: OBJECTIVES: 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. DESIGN: This is an observational cohort study. METHODS: 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. RESULTS: 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. CONCLUSION: 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.
Language: en
ISSN: 1473-5571
Rights: Published by Wolters Kluwer Lippincott Williams & Wilkins - Archived on this site by kind permission Wolters Kluwer
Appears in topics: HIV/AIDS

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