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Outcomes after two years of providing antiretroviral treatment in Khayelitsha, South Africa

Coetzee, Davida; Hildebrand, Katherinea; Boulle, Andrewa; Maartens, Garyb; Louis, Francoisec; Labatala, Veliswac; Reuter, Hermannc; Ntwana, Nonthutuzeloc; Goemaere, Ericc

Clinical Science

Background: A community-based antiretroviral therapy (ART) programme was established in 2001 in a South African township to explore the operational issues involved in providing ART in the public sector in resource-limited settings and demonstrate the feasibility of such a service.

Methods: Data was analysed on a cohort of patients with symptomatic HIV disease and a CD4 lymphocyte count < 200 × 106 cells/l. The programme used standardized protocols (using generic medicines whenever possible), a team-approach to clinical care and a patient-centred approach to promote adherence.

Results: Two-hundred and eighty-seven adults naive to prior ART were followed for a median duration of 13.9 months. The median CD4 lymphocyte count was 43 × 106 cells/l at initiation of treatment, and the mean log10 HIV RNA was 5.18 copies/ml. The HIV RNA level was undetectable (< 400 copies/ml) in 88.1, 89.2, 84.2, 75.0 and 69.7% of patients at 3, 6, 12, 18 and 24 months respectively. The cumulative probability of remaining alive was 86.3% at 24 months on treatment for all patients, 91.4% for those with a baseline CD4 lymphocyte count ≥ 50 × 106 cells/l, and 81.8% for those with a baseline CD4 lymphocyte count < 50 × 106 cells/l. The cumulative probability of changing a single antiretroviral drug by 24 months was 15.1% due to adverse events or contraindications, and 8.4% due to adverse events alone.

Conclusions: ART can be provided in resource-limited settings with good patient retention and clinical outcomes. With responsible implementation, ART is a key component of a comprehensive response to the epidemic in those communities most affected by HIV.

From the aInfectious Disease Epidemiology Unit, School of Public Health and Family Medicine and the bDepartment of Medicine, University of Cape Town, South Africa, and cMédecins Sans Frontières, South Africa.

Correspondence to D. Coetzee, Infectious Disease Epidemiology Unit, School of Public Health and Family Medicine, University of Cape Town, Anzio Road, Observatory 7925, South Africa.

Received: 5 August 2003; revised: 4 February 2004; accepted: 11 February 2004

© 2004 Lippincott Williams & Wilkins, Inc.