Antiretroviral treatment outcomes from a nurse-driven, community-supported HIV/AIDS treatment programme in rural Lesotho: observational cohort assessment at two years

 

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dc.contributor.author Cohen, Rachel en_ZA
dc.contributor.author Lynch, Sharonann en_ZA
dc.contributor.author Bygrave, Helen en_ZA
dc.contributor.author Eggers, Evi en_ZA
dc.contributor.author Vlahakis, Natalie en_ZA
dc.contributor.author Hilderbrand, Katherine en_ZA
dc.contributor.author Knight, Louise en_ZA
dc.contributor.author Pillay, Prinitha en_ZA
dc.contributor.author Saranchuk, Peter en_ZA
dc.contributor.author Goemaere, Eric en_ZA
dc.contributor.author Makakole, Lipontso en_ZA
dc.contributor.author Ford, Nathan en_ZA
dc.date.accessioned 2015-10-30T09:30:50Z
dc.date.available 2015-10-30T09:30:50Z
dc.date.issued 2009 en_ZA
dc.identifier.citation Cohen, R., Lynch, S., Bygrave, H., Eggers, E., Vlahakis, N., Hilderbrand, K., ... & Ford, N. (2009). Antiretroviral treatment outcomes from a nurse-driven, community-supported HIV/AIDS treatment programme in rural Lesotho: observational cohort assessment at two years. Journal of the International AIDS Society, 12(1), 23. en_ZA
dc.identifier.uri http://hdl.handle.net/11427/14511
dc.identifier.uri http://dx.doi.org/10.1186/1758-2652-12-23
dc.description.abstract INTRODUCTION:Lesotho has the third highest HIV prevalence in the world (an adult prevalence of 23.2%). Despite a lack of resources for health, the country has implemented state-of-the-art antiretroviral treatment guidelines, including early initiation of treatment (<350 cells/mm3), tenofovir in first line, and nurse-initiated and managed HIV care, including antiretroviral therapy (ART), at primary health care level.PROGRAMME APPROACH:We describe two-year outcomes of a decentralized HIV/AIDS care programme run by Doctors Without Borders/Medecins Sans Frontieres, the Ministry of Health and Social Welfare, and the Christian Health Association of Lesotho in Scott catchment area, a rural health zone covering 14 clinics and one district hospital. Outcome data are described through a retrospective cohort analysis of adults and children initiated on ART between 2006 and 2008.DISCUSSION AND EVALUATION:Overall, 13,243 people have been enrolled in HIV care (5% children), and 5376 initiated on ART (6.5% children), 80% at primary care level. Between 2006 and 2008, annual enrolment more than doubled for adults and children, with no major external increase in human resources. The proportion of adults arriving sick (CD4 <50 cells/mm3) decreased from 22.2% in 2006 to 11.9% in 2008. Twelve-month outcomes are satisfactory in terms of mortality (11% for adults; 9% for children) and loss to follow up (8.8%). At 12 months, 80% of adults and 89% of children were alive and in care, meaning they were still taking their treatment; at 24 months, 77% of adults remained in care. CONCLUSION: Despite major resource constraints, Lesotho is comparing favourably with its better resourced neighbour, using the latest international ART recommendations. The successful two-year outcomes are further evidence that HIV/AIDS care and treatment can be provided effectively at the primary care level. The programme highlights how improving HIV care strengthened the primary health care system, and validates several critical areas for task shifting that are being considered by other countries in the region, including nurse-driven ART for adults and children, and lay counsellor-supported testing and counselling, adherence and case management. en_ZA
dc.language.iso eng en_ZA
dc.publisher BioMed Central Ltd en_ZA
dc.rights This is an open access article distributed under the terms of the Creative Commons Attribution License en_ZA
dc.rights.uri http://creativecommons.org/licenses/by/2.0 en_ZA
dc.source Journal of the International AIDS Society en_ZA
dc.source.uri http://www.biomedcentral.com/1758-2652/ en_ZA
dc.subject.other Antiretroviral treatment en_ZA
dc.subject.other HIV/AIDS treatment programmes en_ZA
dc.title Antiretroviral treatment outcomes from a nurse-driven, community-supported HIV/AIDS treatment programme in rural Lesotho: observational cohort assessment at two years en_ZA
dc.type Journal Article en_ZA
dc.rights.holder 2009 Cohen et al; licensee BioMed Central Ltd en_ZA
uct.type.publication Research en_ZA
uct.type.resource Article en_ZA
dc.publisher.institution University of Cape Town
dc.publisher.faculty Faculty of Health Sciences en_ZA
dc.publisher.department Institute of Infectious Disease and Molecular Medicine en_ZA
uct.type.filetype Text
uct.type.filetype Image
dc.identifier.apacitation Cohen, R., Lynch, S., Bygrave, H., Eggers, E., Vlahakis, N., Hilderbrand, K., ... Ford, N. (2009). Antiretroviral treatment outcomes from a nurse-driven, community-supported HIV/AIDS treatment programme in rural Lesotho: observational cohort assessment at two years. <i>Journal of the International AIDS Society</i>, http://hdl.handle.net/11427/14511 en_ZA
dc.identifier.chicagocitation Cohen, Rachel, Sharonann Lynch, Helen Bygrave, Evi Eggers, Natalie Vlahakis, Katherine Hilderbrand, Louise Knight, et al "Antiretroviral treatment outcomes from a nurse-driven, community-supported HIV/AIDS treatment programme in rural Lesotho: observational cohort assessment at two years." <i>Journal of the International AIDS Society</i> (2009) http://hdl.handle.net/11427/14511 en_ZA
dc.identifier.vancouvercitation Cohen R, Lynch S, Bygrave H, Eggers E, Vlahakis N, Hilderbrand K, et al. Antiretroviral treatment outcomes from a nurse-driven, community-supported HIV/AIDS treatment programme in rural Lesotho: observational cohort assessment at two years. Journal of the International AIDS Society. 2009; http://hdl.handle.net/11427/14511. en_ZA
dc.identifier.ris TY - Journal Article AU - Cohen, Rachel AU - Lynch, Sharonann AU - Bygrave, Helen AU - Eggers, Evi AU - Vlahakis, Natalie AU - Hilderbrand, Katherine AU - Knight, Louise AU - Pillay, Prinitha AU - Saranchuk, Peter AU - Goemaere, Eric AU - Makakole, Lipontso AU - Ford, Nathan AB - INTRODUCTION:Lesotho has the third highest HIV prevalence in the world (an adult prevalence of 23.2%). Despite a lack of resources for health, the country has implemented state-of-the-art antiretroviral treatment guidelines, including early initiation of treatment (<350 cells/mm3), tenofovir in first line, and nurse-initiated and managed HIV care, including antiretroviral therapy (ART), at primary health care level.PROGRAMME APPROACH:We describe two-year outcomes of a decentralized HIV/AIDS care programme run by Doctors Without Borders/Medecins Sans Frontieres, the Ministry of Health and Social Welfare, and the Christian Health Association of Lesotho in Scott catchment area, a rural health zone covering 14 clinics and one district hospital. Outcome data are described through a retrospective cohort analysis of adults and children initiated on ART between 2006 and 2008.DISCUSSION AND EVALUATION:Overall, 13,243 people have been enrolled in HIV care (5% children), and 5376 initiated on ART (6.5% children), 80% at primary care level. Between 2006 and 2008, annual enrolment more than doubled for adults and children, with no major external increase in human resources. The proportion of adults arriving sick (CD4 <50 cells/mm3) decreased from 22.2% in 2006 to 11.9% in 2008. Twelve-month outcomes are satisfactory in terms of mortality (11% for adults; 9% for children) and loss to follow up (8.8%). At 12 months, 80% of adults and 89% of children were alive and in care, meaning they were still taking their treatment; at 24 months, 77% of adults remained in care. CONCLUSION: Despite major resource constraints, Lesotho is comparing favourably with its better resourced neighbour, using the latest international ART recommendations. The successful two-year outcomes are further evidence that HIV/AIDS care and treatment can be provided effectively at the primary care level. The programme highlights how improving HIV care strengthened the primary health care system, and validates several critical areas for task shifting that are being considered by other countries in the region, including nurse-driven ART for adults and children, and lay counsellor-supported testing and counselling, adherence and case management. DA - 2009 DB - OpenUCT DO - 10.1186/1758-2652-12-23 DP - University of Cape Town J1 - Journal of the International AIDS Society LK - https://open.uct.ac.za PB - University of Cape Town PY - 2009 T1 - Antiretroviral treatment outcomes from a nurse-driven, community-supported HIV/AIDS treatment programme in rural Lesotho: observational cohort assessment at two years TI - Antiretroviral treatment outcomes from a nurse-driven, community-supported HIV/AIDS treatment programme in rural Lesotho: observational cohort assessment at two years UR - http://hdl.handle.net/11427/14511 ER - en_ZA


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