Scale-up of a decentralised HIV treatment programme in rural KwaZulu- Natal, South Africa: does rapid expansion affect patient outcomes?. Bull WHO, 88: 593-600 (2010).

Publication Latest Publications

Title: Scale-up of a decentralised HIV treatment programme in rural KwaZulu- Natal, South Africa: does rapid expansion affect patient outcomes?
Authors: Mutevedzi P, Lessells RJ, Heller T, Barnighausen T, Cooke G, Newell ML.
Journal: Bull WHO,88:593-600 (2010)

Journal Impact Factor (I.F.): 5.459
Number of citations (Google Scholar): 31

Abstract

Objective To describe the scale-up of a decentralized HIV treatment programme delivered through the primary health care system in rural KwaZulu-Natal, South Africa, and to assess trends in baseline characteristics and outcomes in the study population.

Methods The programme started delivery of antiretroviral therapy (ART) in October 2004. Information on all patients initiated on ART was captured in the programme database and follow-up status was updated monthly. All adult patients (? 16 years) who initiated ART between October 2004 and September 2008 were included and stratified into 6-month groups. Clinical and sociodemographic characteristics were compared between the groups. Retention in care, mortality, loss to follow-up and virological outcomes were assessed at 12 months post-ART initiation.

Findings A total of 5719 adults initiated on ART were included (67.9% female). Median baseline CD4+ lymphocyte count was 116 cells/?l (interquartile range, IQR: 53?173). There was an increase in the proportion of women who initiated ART while pregnant but no change in other baseline characteristics over time. Overall retention in care at 12 months was 84.0% (95% confidence interval, CI: 82.6?85.3); 10.9% died (95% CI: 9.8?12.0); 3.7% were lost to follow-up (95% CI: 3.0?4.4). Mortality was highest in the first 3 months after ART initiation: 30.1 deaths per 100 person?years (95% CI: 26.3?34.5). At 12 months 23.0% had a detectable viral load (> 25 copies/ml) (95% CI: 19.5?25.5).

Conclusion Outcomes were not affected by rapid expansion of this decentralized HIV treatment programme. The relatively high rates of detectable viral load highlight the need for further efforts to improve the quality of services.

Download: Full text paper

Citation: Mutevedzi P, Lessells RJ, Heller T, Barnighausen T, Cooke G, Newell ML. Scale-up of a decentralised HIV treatment programme in rural KwaZulu- Natal, South Africa: does rapid expansion affect patient outcomes? Bull WHO,88:593-600 (2010).


Sexual partnership age pairings and risk of HIV acquisition in rural South Africa
Journal: AIDS (2017)

Incidence rate estimation, periodic testing and the limitations of the mid-point imputation approach
Journal: International Journal of Epidemiology (2017)

Mutational Correlates of Virological Failure in Individuals Receiving a WHO-Recommended Tenofovir-Containing First-Line Regimen: An International Collaboration
Journal: EBioMedicine (2017)
All publications...


KwaZulu-Natal Research Innovation and Sequencing Platform (KRISP), K-RITH Tower Building, Nelson R Mandela School of Medicine, UKZN

Contact: Prof. Tulio de Oliveira, Tel: +27 31 260 4898, Email: tuliodna@gmail.com & deoliveira@ukzn.ac.za

Page design updated 2013. Many of the pages were previously hosted at bioafrica.net.