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Publication Details
AFRICAN RESEARCH NEXUS
SHINING A SPOTLIGHT ON AFRICAN RESEARCH
Temporal changes in programme outcomes among adult patients initiating antiretroviral therapy across South Africa, 2002-2007
AIDS, Volume 24, No. 14, Year 2010
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Description
Objective: 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. © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins.
Authors & Co-Authors
Cornell, M.
South Africa, Cape Town
University of Cape Town
South Africa, Johannesburg
University of the Witwatersrand
Grimsrud, Anna Thora
South Africa, Cape Town
University of Cape Town
Fairall, Lara R.
South Africa, Cape Town
University of Cape Town Lung Institute
South Africa, Cape Town
University of Cape Town
Fox, Matthew P.
United States, Boston
School of Public Health
South Africa, Johannesburg
University of the Witwatersrand
Van Cutsem, Gilles
South Africa, Cape Town
University of Cape Town
Switzerland, Geneva
Medecins Sans Frontieres
Giddy, Janet
South Africa, Durban
Mccord Hospital
Wood, Robin Y.
South Africa, Cape Town
University of Cape Town
Prozesky, Hans (Hw)
South Africa, Tygerberg
Tygerberg Hospital
Mohapi, Lerato
South Africa, Johannesburg
University of the Witwatersrand
Graber, Claire
Switzerland, Bern
University of Bern
Egger, Matthias
Switzerland, Bern
University of Bern
United Kingdom, Bristol
University of Bristol
Boulle, Andrew
South Africa, Cape Town
University of Cape Town
Myer, Landon
South Africa, Cape Town
University of Cape Town
United States
International Center for Aids Care
Statistics
Citations: 247
Authors: 13
Affiliations: 10
Identifiers
Doi:
10.1097/QAD.0b013e32833d45c5
e-ISSN:
14735571
Research Areas
Health System And Policy
Study Design
Cohort Study
Study Locations
South Africa
Participants Gender
Female