Temporal changes in programme outcomes among adult patients initiating antiretroviral therapy across South Africa, 2002-2007.
Fox, Matthew P
van Cutsem, Gilles
AffiliationCentre for Infectious Disease Epidemiology & Research, University of Cape Town, South Africa. firstname.lastname@example.org
MetadataShow full item record
JournalAIDS (London, England)
AbstractOBJECTIVE: Little is known about the temporal impact of the rapid scale-up of large antiretroviral therapy (ART) services on programme outcomes. We describe patient outcomes [mortality, loss-to-follow-up (LTFU) and retention] over time in a network of South African ART cohorts. DESIGN: Cohort analysis utilizing routinely collected patient data. METHODS: Analysis included adults initiating ART in eight public sector programmes across South Africa, 2002-2007. Follow-up was censored at the end of 2008. Kaplan-Meier methods were used to estimate time to outcomes, and proportional hazards models to examine independent predictors of outcomes. RESULTS: Enrolment (n = 44 177, mean age 35 years; 68% women) increased 12-fold over 5 years, with 63% of patients enrolled in the past 2 years. Twelve-month mortality decreased from 9% to 6% over 5 years. Twelve-month LTFU increased annually from 1% (2002/2003) to 13% (2006). Cumulative LTFU increased with follow-up from 14% at 12 months to 29% at 36 months. With each additional year on ART, failure to retain participants was increasingly attributable to LTFU compared with recorded mortality. At 12 and 36 months, respectively, 80 and 64% of patients were retained. CONCLUSION: Numbers on ART have increased rapidly in South Africa, but the programme has experienced deteriorating patient retention over time, particularly due to apparent LTFU. This may represent true loss to care, but may also reflect administrative error and lack of capacity to monitor movements in and out of care. New strategies are needed for South Africa and other low-income and middle-income countries to improve monitoring of outcomes and maximize retention in care with increasing programme size.
- Loss to follow-up in a community clinic in South Africa--roles of gender, pregnancy and CD4 count.
- Authors: Wang B, Losina E, Stark R, Munro A, Walensky RP, Wilke M, Martin D, Lu Z, Freedberg KA, Wood R
- Issue date: 2011 Apr
- CD4 count at antiretroviral therapy initiation and the risk of loss to follow-up: results from a multicentre cohort study.
- Authors: Grimsrud A, Cornell M, Schomaker M, Fox MP, Orrell C, Prozesky H, Stinson K, Tanser F, Egger M, Myer L, International Epidemiologic Databases to Evaluate AIDS Southern Africa Collaboration (IeDEA-SA).
- Issue date: 2016 Jun
- Outcomes of antiretroviral therapy over a 10-year period of expansion: a multicohort analysis of African and Asian HIV programs.
- Authors: Grimsrud A, Balkan S, Casas EC, Lujan J, Van Cutsem G, Poulet E, Myer L, Pujades-Rodriguez M
- Issue date: 2014 Oct 1
- The impact of gender and income on survival and retention in a South African antiretroviral therapy programme.
- Authors: Cornell M, Myer L, Kaplan R, Bekker LG, Wood R
- Issue date: 2009 Jul
- Predictors of loss to follow-up among children in the first and second years of antiretroviral treatment in Johannesburg, South Africa.
- Authors: Sengayi M, Dwane N, Marinda E, Sipambo N, Fairlie L, Moultrie H
- Issue date: 2013 Jan 24