Rapid scale-up of A community-based HIV treatment service: Programme performance over 3 consecutive years in Guguletu, South Africa
| dc.contributor.author | Bekker, Linda-Gail | |
| dc.contributor.author | Myer, Landon | |
| dc.contributor.author | Orrell, Catherine | |
| dc.contributor.author | Lawn, Steve | |
| dc.contributor.author | Wood, Robin | |
| dc.date.accessioned | 2017-05-18T07:37:27Z | |
| dc.date.available | 2017-05-18T07:37:27Z | |
| dc.date.issued | 2006 | |
| dc.date.updated | 2016-01-08T08:42:54Z | |
| dc.description.abstract | Background. Despite rapid expansion of antiretroviral therapy (ART) in sub-Saharan Africa there are few longitudinal data describing programme performance during rapid scale-up. Methods. We compared mortality, viral suppression and programme retention in 3 consecutive years of a public sector community-based ART clinic in a South African township. Data were collected prospectively from establishment of services in October 2002 to the censoring date in September 2005. Viral load and CD4 counts were monitored at 4-monthly intervals. Community-based counsellors provided adherence and programme support. Results. During the study period 1 139 ART-naïve patients received ART (161, 280 and 698 in the 1st, 2nd and 3rd years respectively). The median CD4 cell counts were 84 cells/μl (interquartile range (IQR) 42 - 139), 89 cells/μl (IQR 490 - 149), and 110 cells/μl (IQR 55 - 172), and the proportions of patients with World Health Organization (WHO) clinical stages 3 and 4 were 90%, 79% and 76% in each sequential year respectively. The number of counsellors increased from 6 to 28 and the median number of clients allocated to each counsellor increased from 13 to 33. The overall loss to follow-up was 2.9%. At the date of censoring, the Kaplan-Meier estimates of the proportion of patients still on the programme were 82%, 86% and 91%, and the proportion who were virally suppressed (< 400 copies/ml) were 100%, 92% and 98% for the 2002, 2003 and 2004 cohorts respectively. Conclusions. While further operational research is required into optimal models of care in different populations across sub-Saharan Africa, these results demonstrate that a single community-based public sector ART clinic can extend care to over 1 000 patients in an urban setting without compromising programme performance. | |
| dc.identifier | http://dx.doi.org/10.7196/SAMJ.1072 | |
| dc.identifier.apacitation | Bekker, L., Myer, L., Orrell, C., Lawn, S., & Wood, R. (2006). Rapid scale-up of A community-based HIV treatment service: Programme performance over 3 consecutive years in Guguletu, South Africa. <i>South African Medical Journal</i>, http://hdl.handle.net/11427/24357 | en_ZA |
| dc.identifier.chicagocitation | Bekker, Linda-Gail, Landon Myer, Catherine Orrell, Steve Lawn, and Robin Wood "Rapid scale-up of A community-based HIV treatment service: Programme performance over 3 consecutive years in Guguletu, South Africa." <i>South African Medical Journal</i> (2006) http://hdl.handle.net/11427/24357 | en_ZA |
| dc.identifier.citation | Bekker, L., Myer, L., Orrell, C., Lawn, S., & Wood, R. (2008). Rapid scale-up of a community-based HIV treatment service: Programme performance over 3 consecutive years in Guguletu, South Africa. South African Medical Journal, 96(4), 315. | |
| dc.identifier.ris | TY - Journal Article AU - Bekker, Linda-Gail AU - Myer, Landon AU - Orrell, Catherine AU - Lawn, Steve AU - Wood, Robin AB - Background. Despite rapid expansion of antiretroviral therapy (ART) in sub-Saharan Africa there are few longitudinal data describing programme performance during rapid scale-up. Methods. We compared mortality, viral suppression and programme retention in 3 consecutive years of a public sector community-based ART clinic in a South African township. Data were collected prospectively from establishment of services in October 2002 to the censoring date in September 2005. Viral load and CD4 counts were monitored at 4-monthly intervals. Community-based counsellors provided adherence and programme support. Results. During the study period 1 139 ART-naïve patients received ART (161, 280 and 698 in the 1st, 2nd and 3rd years respectively). The median CD4 cell counts were 84 cells/μl (interquartile range (IQR) 42 - 139), 89 cells/μl (IQR 490 - 149), and 110 cells/μl (IQR 55 - 172), and the proportions of patients with World Health Organization (WHO) clinical stages 3 and 4 were 90%, 79% and 76% in each sequential year respectively. The number of counsellors increased from 6 to 28 and the median number of clients allocated to each counsellor increased from 13 to 33. The overall loss to follow-up was 2.9%. At the date of censoring, the Kaplan-Meier estimates of the proportion of patients still on the programme were 82%, 86% and 91%, and the proportion who were virally suppressed (< 400 copies/ml) were 100%, 92% and 98% for the 2002, 2003 and 2004 cohorts respectively. Conclusions. While further operational research is required into optimal models of care in different populations across sub-Saharan Africa, these results demonstrate that a single community-based public sector ART clinic can extend care to over 1 000 patients in an urban setting without compromising programme performance. DA - 2006 DB - OpenUCT DP - University of Cape Town J1 - South African Medical Journal LK - https://open.uct.ac.za PB - University of Cape Town PY - 2006 T1 - Rapid scale-up of A community-based HIV treatment service: Programme performance over 3 consecutive years in Guguletu, South Africa TI - Rapid scale-up of A community-based HIV treatment service: Programme performance over 3 consecutive years in Guguletu, South Africa UR - http://hdl.handle.net/11427/24357 ER - | en_ZA |
| dc.identifier.uri | http://hdl.handle.net/11427/24357 | |
| dc.identifier.vancouvercitation | Bekker L, Myer L, Orrell C, Lawn S, Wood R. Rapid scale-up of A community-based HIV treatment service: Programme performance over 3 consecutive years in Guguletu, South Africa. South African Medical Journal. 2006; http://hdl.handle.net/11427/24357. | en_ZA |
| dc.language.iso | eng | |
| dc.publisher.department | Desmond Tutu HIV Centre | en_ZA |
| dc.publisher.faculty | Faculty of Health Sciences | en_ZA |
| dc.publisher.institution | University of Cape Town | |
| dc.source | South African Medical Journal | |
| dc.source.uri | http://www.samj.org.za/index.php/samj | |
| dc.subject.other | Programme performance | |
| dc.subject.other | Guguletu | |
| dc.subject.other | Public sector | |
| dc.subject.other | Mortality | |
| dc.subject.other | Viral suppression | |
| dc.subject.other | Programme retention | |
| dc.title | Rapid scale-up of A community-based HIV treatment service: Programme performance over 3 consecutive years in Guguletu, South Africa | |
| dc.type | Journal Article | en_ZA |
| uct.type.filetype | Text | |
| uct.type.filetype | Image | |
| uct.type.publication | Research | en_ZA |
| uct.type.resource | Article | en_ZA |