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Publication Details
AFRICAN RESEARCH NEXUS
SHINING A SPOTLIGHT ON AFRICAN RESEARCH
Outcomes in patients waiting for antiretroviral treatment in the Free State Province, South Africa: Prospective linkage study
AIDS, Volume 24, No. 17, Year 2010
Notification
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Description
Objective: In South Africa, many HIV-infected patients experience delays in accessing antiretroviral therapy (ART). We examined pretreatment mortality and access to treatment in patients waiting for ART. Design: Cohort of HIV-infected patients assessed for ART eligibility at 36 facilities participating in the Comprehensive HIV and AIDS Management (CHAM) program in the Free State Province. Methods: Proportion of patients initiating ART, pre-ART mortality and risk factors associated with these outcomes were estimated using competing risks survival analysis. Results: Forty-four thousand, eight hundred and forty-four patients enrolled in CHAM between May 2004 and December 2007, of whom 22 083 (49.2%) were eligible for ART; pre-ART mortality was 53.2 per 100 person-years [95% confidence interval (CI) 51.8-54.7]. Median CD4 cell count at eligibility increased from 87 cells/μl in 2004 to 101 cells/μl in 2007. Two years after eligibility an estimated 67.7% (67.1-68.4%) of patients had started ART, and 26.2% (25.6-26.9%) died before starting ART. Among patients with CD4 cell counts below 25 cells/μl at eligibility, 48% died before ART and 51% initiated ART. Men were less likely to start treatment and more likely to die than women. Patients in rural clinics or clinics with low staffing levels had lower rates of starting treatment and higher mortality compared with patients in urban/peri-urban clinics, or better staffed clinics. Conclusions: Mortality is high in eligible patients waiting for ART in the Free State Province. The most immunocompromised patients had the lowest probability of starting ART and the highest risk of pre-ART death. Prioritization of these patients should reduce waiting times and pre-ART mortality. © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins.
Authors & Co-Authors
Ingle, Suzanne M.
United Kingdom, Bristol
University of Bristol
May, Margaret T.
United Kingdom, Bristol
University of Bristol
Uebel, Kerry E.
South Africa, Cape Town
University of Cape Town Lung Institute
Timmerman, Venessa
South Africa, Cape Town
University of Cape Town Lung Institute
Kotzé, Eduan
South Africa, Bloemfontein
Free State Department of Health
Bachmann, Max Oscar
United Kingdom, Norwich
University of East Anglia, Norwich Medical School
Sterne, Jonathan A.C.
United Kingdom, Bristol
University of Bristol
Egger, Matthias
Switzerland, Bern
University of Bern
Fairall, Lara R.
United Kingdom, Norwich
University of East Anglia, Norwich Medical School
South Africa, Cape Town
University of Cape Town
Statistics
Citations: 99
Authors: 9
Affiliations: 6
Identifiers
Doi:
10.1097/QAD.0b013e32833fb71f
e-ISSN:
14735571
Research Areas
Health System And Policy
Infectious Diseases
Study Design
Cohort Study
Study Locations
South Africa
Participants Gender
Male
Female