Rapid scale-up of a community-based HIV treatment service - Programme performance over 3 consecutive years in Guguletu, South Africa

Bekker, LG; Myer, L; Orrell, C; Lawn, S; Wood, R; (2006) Rapid scale-up of a community-based HIV treatment service - Programme performance over 3 consecutive years in Guguletu, South Africa. South African Medical Journal, 96 (4). pp. 315-320. ISSN 0256-9574

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Background. Despite rapid expansion of antiretroviral therapy (ART) in sub-Saharan Africa there are few longitudinal data describing programme performance during rapid scale-up. Methods. We compared mortality, viral suppression and programme retention in 3 consecutive years of a public sector community-based ART clinic in a South African township. Data were collected prospectively from establishment of services in October 2002 to the censoring date in September 2005. Viral load and CD4 counts were monitored at 4-monthly intervals. Community-based counsellors provided adherence and programme support. Results. During the study period 1 139 ART-naive patients received ART (161, 280 and 698 in the 1st, 2nd and 3rd years respectively). The median CD4 cell counts were 84 cells/mu l (interquartile range (IQR) 42 - 139), 89 cells/mu l (IQR 490 - 149), and 110 cells/mu l (IQR 55 - 172), and the proportions of patients with World Health Organization (WHO) clinical stages 3 and 4 were 90%, 79% and 76% in each sequential year respectively. The number of counsellors increased from 6 to 28 and the median number of clients allocated to each counsellor increased from 13 to 33. The overall loss to follow-up was 2.9%. At the date of censoring, the Kaplan-Meier estimates of the proportion of patients still on the programme were 82%, 86% and 91%, and the proportion who were virally suppressed (< 400 copies/ml) were 100%, 92% and 98% for the 2002, 2003 and 2004 cohorts respectively. Conclusions. While further operational research is required into optimal models of care in different populations across sub-Saharan Africa, these results demonstrate that a single community-based public sector ART clinic can extend care to over 1000 patients in an urban setting without compromising programme performance.

Item Type: Article
Keywords: ACTIVE ANTIRETROVIRAL THERAPY, RESOURCE-POOR SETTINGS, SUB-SAHARAN, AFRICA, EXPERIENCE, SURVIVAL, LESSONS, AIDS, Adolescent, Adult, Anti-HIV Agents, therapeutic use, CD4 Lymphocyte Count, Child, Child, Preschool, DNA, Viral, analysis, Female, Follow-Up Studies, HIV, genetics, HIV Infections, drug therapy, epidemiology, virology, Humans, Incidence, Infant, Male, Middle Aged, Pregnancy, Program Evaluation, trends, Prospective Studies, South Africa, epidemiology, Time Factors, Treatment Outcome, Viral Load
Faculty and Department: Faculty of Infectious and Tropical Diseases > Dept of Clinical Research
PubMed ID: 16670804
Web of Science ID: 237025400034
URI: http://researchonline.lshtm.ac.uk/id/eprint/6477


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