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Evaluation of a workplace HIV treatment programme in South Africa

Charalambous, Salomea; Innes, Craiga; Muirhead, Debbiea,b; Kumaranayake, Lilanib; Fielding, Katherineb; Pemba, Lindiwea; Hamilton, Robina; Grant, Alisonb; Churchyard, Gavin Ja,b,c

doi: 10.1097/01.aids.0000279696.63438.aa
Original articles

Objective: To review the experience of implementing a workplace HIV care programme in South Africa and describe treatment outcomes in sequential cohorts of individuals starting antiretroviral therapy (ART).

Design: A review of an industrial HIV care and treatment programme. Between October 2002 and December 2005, 2262 patients enrolled in the HIV care programme.

Results: CD4 cell counts increased by a median of 90, 113 and 164 cells/μl by 6, 12 and 24 months on treatment, respectively. The viral load was suppressed below 400 copies/ml in 75, 72 and 72% of patients at 6, 12 and 24 months, respectively, at an average cost of US$1654, 3567 and 7883 per patient virally suppressed, respectively. Treatment outcomes in sequential cohorts of patients were consistent over time. A total of 93.6% of patients at 14 752 clinic visits reported missing no tablets over the previous 3 days. Almost half the patients (46.8%) experienced one or more adverse events, although most were mild (78.7%). By the end of December 2005, 30% of patients were no longer on ART, mostly because of defaulted or stopped treatment (12.8%), termination of employment (8.2%), or death (4.9%).

Conclusion: This large workplace programme achieved virological results among individuals retained in the programme comparable to those reported for developed countries; more work is needed to improve retention. Monitoring treatment outcomes in sequential cohorts is a useful way of monitoring programme performance. As the programme has matured, the costs of programme implementation have reduced. Counselling is a central component of an ART programme. Challenges in implementing a workplace ART programme are similar to the challenges of public-sector programmes.

From the aAurum Institute for Health Research, Johannesburg, South Africa

bLondon School of Hygiene and Tropical Medicine, London, UK

cCAPRISA, University of KwaZulu-Natal, KwaZulu-Natal, South Africa.

Correspondence to Salome Charalambous, Aurum Institute for Health Research, PO Box 61587, Marshalltown, South Africa 2107. Tel: +27 011 638 2604; fax: +27 011 638 2608; e-mail: salomec@auruminstitute.org

© 2007 Lippincott Williams & Wilkins, Inc.