Antiretroviral therapy in a community clinic - early lessons from a pilot project

 

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dc.contributor.author Bekker, Linda-Gail
dc.contributor.author Orrell, Catherine
dc.contributor.author Reader, Larissa
dc.contributor.author Matoti, Larissa
dc.contributor.author Cohen, Karen
dc.contributor.author Martell, Rob
dc.contributor.author Abdullah, Fareed
dc.contributor.author Wood, Robin
dc.date.accessioned 2016-01-04T19:45:17Z
dc.date.available 2016-01-04T19:45:17Z
dc.date.issued 2003
dc.identifier.citation Bekker, L. G., et al. (2003). Antiretroviral therapy in a community clinic-early lessons from a pilot project: original article. South African Medical Journal, 93(6), p-458. en_ZA
dc.identifier.issn 0256-9574 en_ZA
dc.identifier.uri http://hdl.handle.net/11427/16202
dc.description.abstract Objectives. To report on operational and clinical problems encountered during the first 6 months of a community-based antiretroviral therapy (ART) programme. Methods. ART was implemented in a primary care setting utilising an easily replicable service-delivery model based on a medical officer and nurse. Therapeutic counsellors, themselves HIV-infected, provided counselling and adherence support. Drug and monitoring costs were charitably funded and provincial health authorities supplied the medical infrastructure. The HIV Research Unit, University of Cape Town, supplied training and additional clinical support. Local HIV primary care clinics provided patient referrals. Standardised ART regimens were used with strict entry criteria (AIDS or CD4 count < 200 cells/µl). Results. Demand for the service was high. Referred patients had advanced disease (AIDS 57%, median CD4 count 96/µl) and high pre-treatment mortality (83/100 person-years). Mycobacterial disease was a major contributor to this mortality (40%). Scheduled clinic visit hours were six times higher during recruitment than maintenance. Attributable costs were: drugs 61%, staff 27%, viral load and CD4 cell counts 10% and safety monitoring 2%. Viral load after 16 weeks of therapy was < 400 copies/ml in the first 16 patients. Conclusions. ART can be successfully implemented within a primary care setting. Drug purchases and staff salaries drive programme costing. The service model is capable of managing 250 - 300 patients on chronic ART, but staffing needs to be increased during recruitment. Attention must be given to the diagnosis of tuberculosis during screening and early ART. Incorporating therapeutic counsellors into the programme increased community involvement and utilised a valuable and previously untapped resource. en_ZA
dc.language eng en_ZA
dc.publisher Health and Medical Publishing Group en_ZA
dc.rights Creative Commons Attribution - Noncommercial 3.0 Unported Works License (CC BY-NC 3.0) *
dc.rights.uri https://creativecommons.org/licenses/by-nc/3.0/ en_ZA
dc.source South African Medical Journal en_ZA
dc.source.uri http://www.samj.org.za/index.php/samj
dc.subject.other HIV / AIDS
dc.subject.other Antiretroviral therapy
dc.subject.other Community health services
dc.subject.other Pilot projects
dc.subject.other South Africa
dc.title Antiretroviral therapy in a community clinic - early lessons from a pilot project en_ZA
dc.type Journal Article en_ZA
dc.date.updated 2015-12-21T11:44:29Z
uct.type.publication Research en_ZA
uct.type.resource Article en_ZA
dc.publisher.institution University of Cape Town
dc.publisher.faculty Faculty of Humanities en_ZA
dc.publisher.department Aids and Society Research Unit en_ZA
uct.type.filetype Text
uct.type.filetype Image
dc.identifier.apacitation Bekker, L., Orrell, C., Reader, L., Matoti, L., Cohen, K., Martell, R., ... Wood, R. (2003). Antiretroviral therapy in a community clinic - early lessons from a pilot project. <i>South African Medical Journal</i>, http://hdl.handle.net/11427/16202 en_ZA
dc.identifier.chicagocitation Bekker, Linda-Gail, Catherine Orrell, Larissa Reader, Larissa Matoti, Karen Cohen, Rob Martell, Fareed Abdullah, and Robin Wood "Antiretroviral therapy in a community clinic - early lessons from a pilot project." <i>South African Medical Journal</i> (2003) http://hdl.handle.net/11427/16202 en_ZA
dc.identifier.vancouvercitation Bekker L, Orrell C, Reader L, Matoti L, Cohen K, Martell R, et al. Antiretroviral therapy in a community clinic - early lessons from a pilot project. South African Medical Journal. 2003; http://hdl.handle.net/11427/16202. en_ZA
dc.identifier.ris TY - Journal Article AU - Bekker, Linda-Gail AU - Orrell, Catherine AU - Reader, Larissa AU - Matoti, Larissa AU - Cohen, Karen AU - Martell, Rob AU - Abdullah, Fareed AU - Wood, Robin AB - Objectives. To report on operational and clinical problems encountered during the first 6 months of a community-based antiretroviral therapy (ART) programme. Methods. ART was implemented in a primary care setting utilising an easily replicable service-delivery model based on a medical officer and nurse. Therapeutic counsellors, themselves HIV-infected, provided counselling and adherence support. Drug and monitoring costs were charitably funded and provincial health authorities supplied the medical infrastructure. The HIV Research Unit, University of Cape Town, supplied training and additional clinical support. Local HIV primary care clinics provided patient referrals. Standardised ART regimens were used with strict entry criteria (AIDS or CD4 count < 200 cells/µl). Results. Demand for the service was high. Referred patients had advanced disease (AIDS 57%, median CD4 count 96/µl) and high pre-treatment mortality (83/100 person-years). Mycobacterial disease was a major contributor to this mortality (40%). Scheduled clinic visit hours were six times higher during recruitment than maintenance. Attributable costs were: drugs 61%, staff 27%, viral load and CD4 cell counts 10% and safety monitoring 2%. Viral load after 16 weeks of therapy was < 400 copies/ml in the first 16 patients. Conclusions. ART can be successfully implemented within a primary care setting. Drug purchases and staff salaries drive programme costing. The service model is capable of managing 250 - 300 patients on chronic ART, but staffing needs to be increased during recruitment. Attention must be given to the diagnosis of tuberculosis during screening and early ART. Incorporating therapeutic counsellors into the programme increased community involvement and utilised a valuable and previously untapped resource. DA - 2003 DB - OpenUCT DP - University of Cape Town J1 - South African Medical Journal LK - https://open.uct.ac.za PB - University of Cape Town PY - 2003 SM - 0256-9574 T1 - Antiretroviral therapy in a community clinic - early lessons from a pilot project TI - Antiretroviral therapy in a community clinic - early lessons from a pilot project UR - http://hdl.handle.net/11427/16202 ER - en_ZA


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