Seven-year experience of a primary care antiretroviral treatment programme in Khayelitsha, South Africa
Top Cited Papers
- 20 February 2010
- journal article
- research article
- Published by Ovid Technologies (Wolters Kluwer Health) in AIDS
- Vol. 24 (4), 563-572
- https://doi.org/10.1097/qad.0b013e328333bfb7
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/μl in 2001 to 131 cells/μl in 2006). Patients who remained virologically suppressed continued to gain CD4 cells at 5 years (median 22 cells/μl 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.This publication has 33 references indexed in Scilit:
- The public health approach to identify antiretroviral therapy failure: high-level nucleoside reverse transcriptase inhibitor resistance among Malawians failing first-line antiretroviral therapyAIDS, 2009
- Five-year outcomes of initial patients treated in Botswana's National Antiretroviral Treatment ProgramAIDS, 2008
- Long-term immunologic response to antiretroviral therapy in low-income countries: a collaborative analysis of prospective studiesAIDS, 2008
- Viral resuppression and detection of drug resistance following interruption of a suppressive non-nucleoside reverse transcriptase inhibitor-based regimenAIDS, 2008
- Utility of CD4 cell counts for early prediction of virological failure during antiretroviral therapy in a resource-limited settingBMC Infectious Diseases, 2008
- Overestimates of Survival after HAART: Implications for Global Scale-Up EffortsPLOS ONE, 2008
- Are previous treatment interruptions associated with higher viral rebound rates in patients with viral suppression?AIDS, 2008
- Patient Retention in Antiretroviral Therapy Programs in Sub-Saharan Africa: A Systematic ReviewPLoS Medicine, 2007
- Rapid Scale-up of Antiretroviral Therapy at Primary Care Sites in ZambiaJama-Journal Of The American Medical Association, 2006
- HIV prevention before HAART in sub-Saharan AfricaThe Lancet, 2002