Five-year experience with scaling-up access to antiretroviral treatment in an HIV care programme in Cambodia.


Thai, S; Koole, O; Un, P; Ros, S; De Munter, P; Van Damme, W; Jacques, G; Colebunders, R; Lynen, L; (2009) Five-year experience with scaling-up access to antiretroviral treatment in an HIV care programme in Cambodia. Tropical medicine & international health, 14 (9). pp. 1048-58. ISSN 1360-2276 DOI: https://doi.org/10.1111/j.1365-3156.2009.02334.x

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Abstract

OBJECTIVES To evaluate a 5-year HIV care programme (2003-2007) in the Sihanouk Hospital Center of HOPE, Phnom Penh, Cambodia. METHODS Analysis of routine programme indicators per year: number of new patients, active patients, antiretroviral therapy (ART) coverage in the cohort, mortality and loss to follow-up. Comparison of mortality before and after the start of ART using Kaplan-Meier survival curves. Analysis of risk factors using Cox regression for the combined endpoint of mortality and loss to follow-up in patients on ART. RESULTS 3844 patients were registered in the hospital between March 2003 and December 2007. The mortality and loss to follow-up rate fell and paralleled the rise of ART coverage from 23% in 2003 to 90% in 2007. The mortality and the loss to follow-up rate was significantly higher in patients not on ART but eligible (Log rank P < 0.001). The combined endpoint of mortality and loss to follow-up was 48.7% after one year in patients who were waiting for ART. 1667 patients were started on ART. The combined endpoint (mortality and loss to follow-up) in this group was 11.5% at 12 months and 14.2% at 24 months. Risk factors for mortality in the ART group were male sex, CD4 count <50 cells/microl, BMI <18 and haemoglobin levels <10 g/dl. CONCLUSION Better access to ART is associated with lower mortality and fewer losses to follow-up. Pre-ART attrition remains significant. Strategies are needed to enable an earlier start of ART and to promote retention in care.

Item Type: Article
Faculty and Department: Faculty of Infectious and Tropical Diseases > Dept of Clinical Research
PubMed ID: 19573140
Web of Science ID: 269263800011
URI: http://researchonline.lshtm.ac.uk/id/eprint/834685

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