The evolution and effectiveness of the South African antiretroviral therapy program

Abstract

Although South Africa has the largest antiretroviral therapy (ART) program worldwide, data on key outcomes like mortality and loss to follow-up (LTF) are limited. A few cohorts have published patient outcomes but there is no national reporting on ART scale-up and its impact on the health of HIV-infected individuals. Yet such monitoring of outcomes is vital to inform and improve service delivery. The International epidemiologic Databases to Evaluate AIDS Southern Africa collaboration (IeDEA-SA) was established in 2005 to collect and analyze individual level data from the larger cohorts of individuals on ART in Southern Africa. Using routine, anonymized data from the South African sites, this thesis aims to describe how the program has evolved over 10 years and to assess its effectiveness .Five quantitative analyses were performed using descriptive statistics and survival analysis methods. The studies used patient-level data on adult patients starting ART to describe characteristics and to explore outcomes and temporal changes in outcomes over time. Patient numbers ranged from 19,481 (limited to cohorts with civil identification numbers) to 83,576 adults, followed for up to 214,400 person years. The results are presented as four published papers and one submitted for publication. The thesis describes a rapid, massive scale-up of services. Despite improvements in baseline immunologic status, late diagnosis and ART initiation especially in men area challenge.