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dc.contributor.authorCornell, Morna
dc.contributor.authorGrimsrud, Anna
dc.contributor.authorFairall, Lara
dc.contributor.authorFox, Matthew P
dc.contributor.authorvan Cutsem, Gilles
dc.contributor.authorGiddy, Janet
dc.contributor.authorWood, Robin
dc.contributor.authorProzesky, Hans
dc.contributor.authorMohapi, Lerato
dc.contributor.authorGraber, Claire
dc.contributor.authorEgger, Matthias
dc.contributor.authorBoulle, Andrew
dc.contributor.authorMyer, Landon
dc.date.accessioned2010-10-08T22:40:03Z
dc.date.available2010-10-08T22:40:03Z
dc.date.issued2010-09-10
dc.identifier.citationTemporal changes in programme outcomes among adult patients initiating antiretroviral therapy across South Africa, 2002-2007. 2010, 24 (14):2263-70 AIDSen
dc.identifier.issn1473-5571
dc.identifier.pmid20683318
dc.identifier.doi10.1097/QAD.0b013e32833d45c5
dc.identifier.urihttp://hdl.handle.net/10144/112716
dc.description.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.
dc.language.isoenen
dc.rightsPublished by Wolters Kluwer Lippincott Williams & Wilkins - Archived on this site by kind permission Wolters Kluweren
dc.titleTemporal changes in programme outcomes among adult patients initiating antiretroviral therapy across South Africa, 2002-2007.en
dc.contributor.departmentCentre for Infectious Disease Epidemiology & Research, University of Cape Town, South Africa. morna@global.co.zaen
dc.identifier.journalAIDS (London, England)en
refterms.dateFOA2019-03-04T08:22:34Z
html.description.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.


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