Temporal changes in programme outcomes among adult patients initiating antiretroviral therapy across South Africa, 2002-2007

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dc.contributor.authorCornell M.
dc.contributor.authorGrimsrud A.
dc.contributor.authorFairall L.
dc.contributor.authorFox M.P.
dc.contributor.authorVan Cutsem G.
dc.contributor.authorGiddy J.
dc.contributor.authorWood R.
dc.contributor.authorProzesky H.
dc.contributor.authorMohapi L.
dc.contributor.authorGraber C.
dc.contributor.authorEgger M.
dc.contributor.authorBoulle A.
dc.contributor.authorMyer L.
dc.date.accessioned2011-05-15T16:15:15Z
dc.date.available2011-05-15T16:15:15Z
dc.date.issued2010
dc.description.abstractObjective: 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.
dc.description.versionArticle
dc.identifier.citationAIDS
dc.identifier.citation24
dc.identifier.citation14
dc.identifier.issn02699370
dc.identifier.other10.1097/QAD.0b013e32833d45c5
dc.identifier.urihttp://hdl.handle.net/10019.1/13254
dc.subjectanti human immunodeficiency virus agent
dc.subjectadolescent
dc.subjectadult
dc.subjectarticle
dc.subjectfemale
dc.subjectfollow up
dc.subjecthighly active antiretroviral therapy
dc.subjecthuman
dc.subjectHuman immunodeficiency virus infection
dc.subjectlowest income group
dc.subjectmajor clinical study
dc.subjectmortality
dc.subjectpatient care
dc.subjectpriority journal
dc.subjectrisk factor
dc.subjectSouth Africa
dc.subjecttreatment outcome
dc.subjectAdolescent
dc.subjectAdult
dc.subjectAnti-Retroviral Agents
dc.subjectCD4 Lymphocyte Count
dc.subjectCohort Studies
dc.subjectFemale
dc.subjectHIV Infections
dc.subjectHIV-1
dc.subjectHumans
dc.subjectMale
dc.subjectOutcome Assessment (Health Care)
dc.subjectPatient Acceptance of Health Care
dc.subjectProgram Evaluation
dc.subjectSouth Africa
dc.subjectYoung Adult
dc.titleTemporal changes in programme outcomes among adult patients initiating antiretroviral therapy across South Africa, 2002-2007
dc.typeArticle
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