Differences in access and patient outcomes across antiretroviral treatment clinics in the Free State province: A prospective cohorot study

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dc.contributor.authorIngle, Suzanne M
dc.contributor.authorMay, Margaret
dc.contributor.authorUebel, Kerry
dc.contributor.authorTimmerman, Venessa
dc.contributor.authorKotze, Eduan
dc.contributor.authorBachmann, Max
dc.contributor.authorSterne, Jonathan A C
dc.contributor.authorEgger, Matthias
dc.contributor.authorFairall, Lara
dc.date.accessioned2017-07-06T07:56:35Z
dc.date.available2017-07-06T07:56:35Z
dc.date.issued2010
dc.date.updated2016-01-12T08:44:09Z
dc.description.abstractObjective. To assess differences in access to antiretroviral treatment (ART) and patient outcomes across public sector treatment facilities in the Free State province, South Africa. Design. Prospective cohort study with retrospective database linkage. We analysed data on patients enrolled in the treatment programme across 36 facilities between May 2004 and December 2007, and assessed percentage initiating ART and percentage dead at 1 year after enrolment. Multivariable logistic regression was used to estimate associations of facility-level and patient-level characteristics with both mortality and treatment status. Results. Of 44 866 patients enrolled, 15 219 initiated treatment within 1 year; 8 778 died within 1 year, 7 286 before accessing ART. Outcomes at 1 year varied greatly across facilities and more variability was explained by facility-level factors than by patient-level factors. The odds of starting treatment within 1 year improved over calendar time. Patients enrolled in facilities with treatment initiation available on site had higher odds of starting treatment and lower odds of death at 1 year compared with those enrolled in facilities that did not offer treatment initiation. Patients were less likely to start treatment if they were male, severely immunosuppressed (CD4 count ≤50 cells/μl), or underweight (<50 kg). Men were also more likely to die in the first year after enrolment. Conclusions. Although increasing numbers of patients started ART between 2004 and 2007, many patients died before accessing ART. Patient outcomes could be improved by decentralisation of treatment services, fast-tracking the most immunodeficient patients and improving access, especially for men.
dc.identifier.apacitationIngle, S. M., May, M., Uebel, K., Timmerman, V., Kotze, E., Bachmann, M., ... Fairall, L. (2010). Differences in access and patient outcomes across antiretroviral treatment clinics in the Free State province: A prospective cohorot study. <i>South African Medical Journal</i>, http://hdl.handle.net/11427/24699en_ZA
dc.identifier.chicagocitationIngle, Suzanne M, Margaret May, Kerry Uebel, Venessa Timmerman, Eduan Kotze, Max Bachmann, Jonathan A C Sterne, Matthias Egger, and Lara Fairall "Differences in access and patient outcomes across antiretroviral treatment clinics in the Free State province: A prospective cohorot study." <i>South African Medical Journal</i> (2010) http://hdl.handle.net/11427/24699en_ZA
dc.identifier.citationIngle, S. M., May, M., Uebel, K., Timmerman, V., Kotze, E., Bachmann, M., ... & Fairall, L. (2010). Differences in access and patient outcomes across antiretroviral treatment clinics in the Free State province: A prospective cohort study. South African Medical Journal, 100(10), 675-681b.
dc.identifier.ris TY - Journal Article AU - Ingle, Suzanne M AU - May, Margaret AU - Uebel, Kerry AU - Timmerman, Venessa AU - Kotze, Eduan AU - Bachmann, Max AU - Sterne, Jonathan A C AU - Egger, Matthias AU - Fairall, Lara AB - Objective. To assess differences in access to antiretroviral treatment (ART) and patient outcomes across public sector treatment facilities in the Free State province, South Africa. Design. Prospective cohort study with retrospective database linkage. We analysed data on patients enrolled in the treatment programme across 36 facilities between May 2004 and December 2007, and assessed percentage initiating ART and percentage dead at 1 year after enrolment. Multivariable logistic regression was used to estimate associations of facility-level and patient-level characteristics with both mortality and treatment status. Results. Of 44 866 patients enrolled, 15 219 initiated treatment within 1 year; 8 778 died within 1 year, 7 286 before accessing ART. Outcomes at 1 year varied greatly across facilities and more variability was explained by facility-level factors than by patient-level factors. The odds of starting treatment within 1 year improved over calendar time. Patients enrolled in facilities with treatment initiation available on site had higher odds of starting treatment and lower odds of death at 1 year compared with those enrolled in facilities that did not offer treatment initiation. Patients were less likely to start treatment if they were male, severely immunosuppressed (CD4 count ≤50 cells/μl), or underweight (<50 kg). Men were also more likely to die in the first year after enrolment. Conclusions. Although increasing numbers of patients started ART between 2004 and 2007, many patients died before accessing ART. Patient outcomes could be improved by decentralisation of treatment services, fast-tracking the most immunodeficient patients and improving access, especially for men. DA - 2010 DB - OpenUCT DP - University of Cape Town J1 - South African Medical Journal LK - https://open.uct.ac.za PB - University of Cape Town PY - 2010 T1 - Differences in access and patient outcomes across antiretroviral treatment clinics in the Free State province: A prospective cohorot study TI - Differences in access and patient outcomes across antiretroviral treatment clinics in the Free State province: A prospective cohorot study UR - http://hdl.handle.net/11427/24699 ER - en_ZA
dc.identifier.urihttp://hdl.handle.net/11427/24699
dc.identifier.vancouvercitationIngle SM, May M, Uebel K, Timmerman V, Kotze E, Bachmann M, et al. Differences in access and patient outcomes across antiretroviral treatment clinics in the Free State province: A prospective cohorot study. South African Medical Journal. 2010; http://hdl.handle.net/11427/24699.en_ZA
dc.language.isoeng
dc.publisher.departmentDivision of Infectious Disease and HIV Meden_ZA
dc.publisher.facultyFaculty of Health Sciencesen_ZA
dc.publisher.institutionUniversity of Cape Town
dc.sourceSouth African Medical Journal
dc.source.urihttp://www.samj.org.za/index.php/samj/index
dc.titleDifferences in access and patient outcomes across antiretroviral treatment clinics in the Free State province: A prospective cohorot study
dc.typeJournal Articleen_ZA
uct.type.filetypeText
uct.type.filetypeImage
uct.type.publicationResearchen_ZA
uct.type.resourceArticleen_ZA
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