Nosimilo Mlangeni1, Flavia Senkubuge. 1. School of Health Systems and Public Health, Faculty of Health Sciences, University of Pretoria, South Africa. milo.mlangeni@yahoo.com.
Abstract
BACKGROUND: Scaling up of antiretroviral therapy (ART) in South Africa (SA) has resulted in an increase in the number of patients on the national ART programme and an increased workload for ART service providers nationwide. OBJECTIVES: To ascertain patient retention on ART after 5 years on treatment in one district of Gauteng Province, SA, establish the number of patients who remained alive on ART after 5 years of treatment, and identify patient-related factors that contributed towards the outcome of each indicator. METHODS: A retrospective cohort study of patients initiated on highly active antiretroviral therapy (HAART) between January and March 2007 was carried out. A sample of 381 patients was randomly selected from 1 004 records, and their records were reviewed for visits over the previous 60 months. Summary statistics, Pearson's χ2 test and linear regression tests were performed. RESULTS: Of 381 patients, 156 (40.9%) remained alive and active on HAART at their initial sites. The overall mortality rate was 5.0% and the rate of long-term retention in care was 57.4%, excluding those transferred to another site. After 6 months on HAART the mean rise in CD4 count was 113 cells/µL, and after 60 months it was 288 cells/µL. Viral load suppression to <400 copies/mL was achieved in 74.0% of patients at 6 months and 91.0% at 60 months. CONCLUSIONS: Immunological and virological outcomes after 5 years on treatment were good. Both these positive outcomes showed that the ART programme was a success. Improved data quality and patient follow-up will further strengthen programme outcomes.
BACKGROUND: Scaling up of antiretroviral therapy (ART) in South Africa (SA) has resulted in an increase in the number of patients on the national ART programme and an increased workload for ART service providers nationwide. OBJECTIVES: To ascertain patient retention on ART after 5 years on treatment in one district of Gauteng Province, SA, establish the number of patients who remained alive on ART after 5 years of treatment, and identify patient-related factors that contributed towards the outcome of each indicator. METHODS: A retrospective cohort study of patients initiated on highly active antiretroviral therapy (HAART) between January and March 2007 was carried out. A sample of 381 patients was randomly selected from 1 004 records, and their records were reviewed for visits over the previous 60 months. Summary statistics, Pearson's χ2 test and linear regression tests were performed. RESULTS: Of 381 patients, 156 (40.9%) remained alive and active on HAART at their initial sites. The overall mortality rate was 5.0% and the rate of long-term retention in care was 57.4%, excluding those transferred to another site. After 6 months on HAART the mean rise in CD4 count was 113 cells/µL, and after 60 months it was 288 cells/µL. Viral load suppression to <400 copies/mL was achieved in 74.0% of patients at 6 months and 91.0% at 60 months. CONCLUSIONS: Immunological and virological outcomes after 5 years on treatment were good. Both these positive outcomes showed that the ART programme was a success. Improved data quality and patient follow-up will further strengthen programme outcomes.