Seven-year experience of a primary care antiretroviral treatment programme in Khayelitsha, South Africa.

Hdl Handle:
http://hdl.handle.net/10144/95573
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
Journal:
AIDS (London, England)
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.
Affiliation:
School of Public Health and Family Medicine, University of Cape Town, Anzio Road, Cape Town, South Africa. andrew.boulle@uct.ac.za
Issue Date:
20-Feb-2010
URI:
http://hdl.handle.net/10144/95573
DOI:
10.1097/QAD.0b013e328333bfb7
PubMed ID:
20057311
Language:
en
ISSN:
1473-5571
Appears in Collections:
HIV/AIDS

Full metadata record

DC FieldValue Language
dc.contributor.authorBoulle, Andrewen
dc.contributor.authorVan Cutsem, Gillesen
dc.contributor.authorHilderbrand, Katherineen
dc.contributor.authorCragg, Carolen
dc.contributor.authorAbrahams, Musaeden
dc.contributor.authorMathee, Shaheeden
dc.contributor.authorFord, Nathanen
dc.contributor.authorKnight, Louiseen
dc.contributor.authorOsler, Megen
dc.contributor.authorMyers, Jonnyen
dc.contributor.authorGoemaere, Ericen
dc.contributor.authorCoetzee, Daviden
dc.contributor.authorMaartens, Garyen
dc.date.accessioned2010-04-05T19:32:13Z-
dc.date.available2010-04-05T19:32:13Z-
dc.date.issued2010-02-20-
dc.identifier.citationSeven-year experience of a primary care antiretroviral treatment programme in Khayelitsha, South Africa. 2010, 24 (4):563-72 AIDSen
dc.identifier.issn1473-5571-
dc.identifier.pmid20057311-
dc.identifier.doi10.1097/QAD.0b013e328333bfb7-
dc.identifier.urihttp://hdl.handle.net/10144/95573-
dc.description.abstractOBJECTIVES: 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.en
dc.language.isoenen
dc.rightsPublished by Wolters Kluwer Lippincott Williams & Wilkins - Archived on this site by kind permission Wolters Kluweren
dc.titleSeven-year experience of a primary care antiretroviral treatment programme in Khayelitsha, South Africa.en
dc.contributor.departmentSchool of Public Health and Family Medicine, University of Cape Town, Anzio Road, Cape Town, South Africa. andrew.boulle@uct.ac.zaen
dc.identifier.journalAIDS (London, England)en
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