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.authorCohen, Rachelen_ZA
dc.contributor.authorLynch, Sharonannen_ZA
dc.contributor.authorBygrave, Helenen_ZA
dc.contributor.authorEggers, Evien_ZA
dc.contributor.authorVlahakis, Natalieen_ZA
dc.contributor.authorHilderbrand, Katherineen_ZA
dc.contributor.authorKnight, Louiseen_ZA
dc.contributor.authorPillay, Prinithaen_ZA
dc.contributor.authorSaranchuk, Peteren_ZA
dc.contributor.authorGoemaere, Ericen_ZA
dc.contributor.authorMakakole, Lipontsoen_ZA
dc.contributor.authorFord, Nathanen_ZA
dc.date.accessioned2015-10-30T09:30:50Z
dc.date.available2015-10-30T09:30:50Z
dc.date.issued2009en_ZA
dc.description.abstractINTRODUCTION: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.identifier.apacitationCohen, 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/11427/14511en_ZA
dc.identifier.chicagocitationCohen, 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/11427/14511en_ZA
dc.identifier.citationCohen, 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.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
dc.identifier.urihttp://hdl.handle.net/11427/14511
dc.identifier.urihttp://dx.doi.org/10.1186/1758-2652-12-23
dc.identifier.vancouvercitationCohen 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.language.isoengen_ZA
dc.publisherBioMed Central Ltden_ZA
dc.publisher.departmentInstitute of Infectious Disease and Molecular Medicineen_ZA
dc.publisher.facultyFaculty of Health Sciencesen_ZA
dc.publisher.institutionUniversity of Cape Town
dc.rightsThis is an open access article distributed under the terms of the Creative Commons Attribution Licenseen_ZA
dc.rights.holder2009 Cohen et al; licensee BioMed Central Ltden_ZA
dc.rights.urihttp://creativecommons.org/licenses/by/2.0en_ZA
dc.sourceJournal of the International AIDS Societyen_ZA
dc.source.urihttp://www.biomedcentral.com/1758-2652/en_ZA
dc.subject.otherAntiretroviral treatmenten_ZA
dc.subject.otherHIV/AIDS treatment programmesen_ZA
dc.titleAntiretroviral treatment outcomes from a nurse-driven, community-supported HIV/AIDS treatment programme in rural Lesotho: observational cohort assessment at two yearsen_ZA
dc.typeJournal Articleen_ZA
uct.type.filetypeText
uct.type.filetypeImage
uct.type.publicationResearchen_ZA
uct.type.resourceArticleen_ZA
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