Antiretroviral therapy in a community clinic - early lessons from a pilot project
| 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.date.updated | 2015-12-21T11:44:29Z | |
| 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.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.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.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 |
| dc.identifier.uri | http://hdl.handle.net/11427/16202 | |
| 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.language | eng | en_ZA |
| dc.publisher | Health and Medical Publishing Group | en_ZA |
| dc.publisher.department | Aids and Society Research Unit | en_ZA |
| dc.publisher.faculty | Faculty of Humanities | en_ZA |
| dc.publisher.institution | University of Cape Town | |
| 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 |
| uct.type.filetype | Text | |
| uct.type.filetype | Image | |
| uct.type.publication | Research | en_ZA |
| uct.type.resource | Article | en_ZA |