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AIDS:
Clinical Science

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

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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

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Abstract

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.

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Introduction

The benefits of antiretroviral therapy (ART) at an individual level are incontrovertible [1,2]. The potential benefits at a population level of successful ART programmes in those countries worst affected by the HIV pandemic are widely argued [3,4]. Even where universal access to ART for those who could benefit from it is not possible, many have argued strongly for ART to be an important component of an integrated response to the epidemic in resource-limited countries [3,5].

The publication by the World Health Organization (WHO) of guidelines for the scaling up of antiretroviral therapy in resource-limited settings [6] signals a convergence of clinical thinking that should, in theory, facilitate the rapid expansion of ART in these settings. Evidence of the effectiveness of public sector ART programmes in those countries with the largest HIV-morbidity and mortality burdens has, however, been slow in emerging. Many interventions have relied on private or out-of-pocket funding of treatment, [7] and where policies exist to provide treatment in the public sector, uptake has been slower than anticipated [8].

The aim of this analysis is to present the early clinical outcomes for adults in a public-sector ART programme in a primary care setting in a poor urban community in South Africa.

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Methods

Setting

Khayelitsha is a township with an estimated population of 400 000 [9]. Housing is both formal and informal. Most residents rely on health services delivered by the state, with unemployment levels considerably higher that the national average [10]. The HIV-1 seroprevalence in public-sector antenatal clinics in this health district in 2002 was 24.9% [11]. Tuberculosis incidence in 2001 was 1062 per 100 000 [12]. In 1999, the first routine programme in South Africa to prevent the transmission of HIV from mother to child was initiated at the two health centres in Khayelitsha that provide maternity services [13]. Dedicated services for adults and children with HIV were established in April 2000 through a collaboration between the provincial government and the international non-governmental organization (NGO) Médecins Sans Frontières (MSF). Three dedicated HIV/AIDS clinics were opened within Khayelitsha's community health centres providing a full package of prophylaxis and treatment of opportunistic infections. In May 2001, the HIV/AIDS clinics began to offer ART. Patients receive ART free of charge. MSF provides the antiretroviral medicines, the HIV RNA tests, and half of the clinical staff, whilst the remaining costs are carried by the provincial government. The study has ethical approval from the South African Medical Association. By the end of July 2003, over 600 adults and children had started ART as part of the programme.

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Patient preparation and selection

Selection criteria required that patients be symptomatic (WHO clinical stage III or IV [14]) and have a CD4 lymphocyte count of < 200 × 106 cells/l. Patients were required to meet a number of additional criteria including: nominating a ‘treatment assistant’ to assist with adherence; receiving a home-visit to verify the family environment, evidence of disclosure and that the patient was indeed resident in Khayelitsha; and, attendance on time for at least three previous appointments over a minimum of 4 months. Each candidate's folder was anonymously presented to a community selection committee.

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Clinical services and regimens

Clinical services are provided in each of the three clinics by a team comprising a doctor, two nurses and two counsellors, with good continuity of care. Reasonable referral networks exist with local hospitals and other primary care services such as tuberculosis services. The consultation frequency for those on ART is determined by the clinical protocol; weekly for the first 2 weeks, then fortnightly until 2 months on ART, monthly until the first year on ART, and 2–3-monthly thereafter. Patients are seen more frequently if clinically indicated. Doctors are mainly responsible for treatment initiation, regimen changes and dealing with specific problems, whilst nurses provide most of the routine patient follow-up for those on ART according to standardized protocols. Plasma HIV RNA measurements are performed at baseline, 3 and 6 months, and CD4 lymphocyte counts are carried out at baseline and 6 months. Both tests are conducted 6-monthly thereafter. Standardized flowchart algorithms for the management of adverse events and virological failure guide doctors and nurses in safety monitoring and when and how to change treatment.

The clinical protocol stipulates that patients begin treatment on zidovudine, lamivudine and either efavirenz or nevirapine. Generic zidovudine, lamivudine, a fixed dose combination of zidovudine and lamivudine, and nevirapine were all procured from the Brazilian state manufacturer FarManguinhos under a compassionate use agreement with the South African Medicines Control Council. The remaining antiretroviral drugs that were used were all fully registered with the Medicines Control Council.

A strong patient-centred approach is used to promote adherence. This includes a comprehensive counselling infrastructure providing for one-on-one individual counselling with trained lay-counsellors, and regular support groups. A treatment access NGO, the Treatment Action Campaign, is active in all three of the clinics, and their activities contribute to the treatment literacy of patients.

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Methods

All adult patients naive to prior ART who started antiretroviral treatment between 29 May 2001 and 31 December 2002 were included in the analysis. Mothers who had received up to 1 month of zidovudine antenatally for the prevention of mother-to-child transmission were included. Patients were considered non-naive and were excluded from the study if they had received more than 1 month of ART as treatment prior to joining the programme. The cohort is ordered and analysed by duration on treatment.

CD4 lymphocyte counts were performed by flow-cytometry. Plasma HIV RNA levels were measured using the nucleic acid sequence-based amplification procedure (NASBA) Nuclisens HIV-1 QT assay (BioMerieux, Boxtel, the Netherlands).

Product-limit estimates (Kaplan–Meier) of survival were determined for all patients irrespective of subsequent discontinuation of therapy. Patients alive and in care on 31 July 2003 were right-censored on the date of their last visit prior to this date. Patients who had not attended services for 3 months or more beyond their last scheduled appointment and who could not be traced were classified as being lost to follow-up and statistically were considered as deaths on their last recorded visit to the clinics. Patients who had ceased attending the clinic but were known to be alive on 31 July 2003 were right-censored on their last visit to the clinic, as were those patients who negotiated their transfer to a different province. The same analysis was repeated stratified by initial CD4 lymphocyte count category, with the log-rank test used to compare survival between the two groups. Cox proportional hazards regression was used to calculate univariate and adjusted hazard ratios (AHR) and confidence intervals (CI) for survival for a number of variables.

Other outcomes included median changes in absolute CD4 lymphocyte counts and the percentage of patients with plasma HIV-RNA measurements < 400 copies/ml at various durations on treatment. Baseline laboratory tests were considered valid if performed within 1 year prior to the initiation of therapy, although most fell within the month prior to ART initiation. Subsequent laboratory outcomes were allocated to the appropriate durations on treatment for all patients on ART at the time of the investigation. A single HIV RNA ≥ 400 copies/ml at any duration on treatment was recorded as being above this value, whilst in instances where HIV RNA measurements were repeated in short succession to confirm elevated levels, and were subsequently found to be below this value, the result for that duration on treatment was recorded as being < 400 copies/ml.

Estimates of the percentage of patients changing treatment were calculated as product-limit estimates. Weight changes were calculated as median increases compared to baseline.

An independent analysis of cause of death developed a functional classification of cause based on data available in the clinical records held at the primary care level for those patients for whom sufficient data was available.

Analyses were performed using STATA software (version 8.0; Stata Corp., College Station, Texas, USA).

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Results

The analysis included 287 adults started on ART (Table 1). One patient was excluded from the analysis due to prior ART. The median follow-up time was 14.9 months for those surviving after starting ART, and 13.9 months for all patients. More women than men accessed treatment (70%). Patients began treatment with advanced disease–the median CD4 lymphocyte count at baseline was 43 × 106 cells/l [interquartile range (IQR), 13–94 × 106 cells/l], with 52% having a prior AIDS diagnosis. These characteristics did not change significantly over the enrolment period. The mean HIV RNA on initiation of treatment was 5.18 log10 copies/ml [standard deviation (SD) 0.68 log10 copies/ml]. Sixty per cent of patients began treatment on zidovudine, lamivudine and efavirenz, and 38% on zidovudine, lamivudine and nevirapine (Table 1).

Table 1
Table 1
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Survival and patient retention

One patient was lost to follow-up soon after commencing treatment. An additional six patients had stopped ART at the time of the analysis but were still attending services. Three patients had transferred to other provinces, and three patients had stopped attending the clinics but were confirmed to still be alive on the 31 July 2003.

Thirty-eight patients died after starting ART. All except two deaths were attributed to HIV, and occurred before 12 months of follow-up (71% before 3 months duration on ART), yielding a product-limit estimate of survival at 24 months of 86.3% (95% CI, 81.7–89.8%) (Fig. 1). One-hundred and fifty-five patients (55%) began treatment with a CD4 lymphocyte count of < 50 × 106 cells/l. Estimates of survival at 24 months stratified by initial CD4 lymphocyte count were 81.8% (95% CI, 74.7–87.0%) for those initiating treatment with a CD4 lymphocyte count < 50 × 106 cells/l and 91.4% (95% CI, 84.9–95.1%) for those with initial CD4 lymphocyte counts > 50 × 106 cells/l (P = 0.0171) (Fig. 2).

Fig. 1
Fig. 1
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Fig. 2
Fig. 2
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In multivariate analysis of baseline variables against survival (Table 2), CD4 lymphocyte count (categorical variable as described above) and a diagnosis of Kaposi's sarcoma (n = 16) were found to be significantly associated with outcome (Table 2)—the AJR of death or loss to follow-up was 2.41 (95% CI, 1.20–4.87) for those in the lower initial CD4 lymphocyte count category compared to the higher category, and 4.82 (95% CI, 2.12–10.97) for a previous diagnosis of Kaposi's sarcoma.

Table 2
Table 2
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In the review of cause of death, 20 deaths were classified as being due to very advanced disease at the time of starting ART, with continued deterioration on treatment. None of these deaths were thought by the reviewer to be attributable to immune-reconstitution disease. The median CD4 lymphocyte count in this group was 7 × 106 cells/l (IQR, 4–25 × 106 cells/l), and the median duration on treatment when they died was 21 days (IQR, 14–31 days). Three patients died as a result of tuberculosis (duration on ART of 6, 145 and 241 days), and three from probable Kaposi's sarcoma (duration on ART of 45, 70 and 79). One patient died after 104 days on ART due to intractable cytomegalovirus colitis that predated ART. Six patients experienced disease progression due to treatment interruption or documented poor adherence. The non-HIV related deaths included a 29-year-old woman with underlying mitral stenosis who died of a cerebrovascular insult 7 months after starting ART, and a 46-year-old man with a squamous cell carcinoma of the lung who died 9 months after starting ART. No deaths were attributed to antiretroviral treatment.

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Other clinical outcomes

The median weight gain at 6 months on treatment was 5.0 kg (IQR, 1.5–9.6 kg) and 9.0 kg (IQR, 4.0–14.3 kg) at 12 months. The percentage of patients with HIV RNA measurements < 400 copies/ml (Fig. 3) was maximal at 6 months (89.2%; 95% CI, 84.4–92.9%), with 84.2% (95% CI, 77.5–89.5%) of patients still having measurements within this range at 12 months, and 69.7% (95% CI, 51.3–84.4%) at 24 months.

Fig. 3
Fig. 3
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The CD4 lymphocyte count increased rapidly compared to the pre-treatment level in the first 6 months on treatment (Fig. 3), increasing by a median of 134 × 106 cells/l (IQR, 76–206 × 106 cells/l). Although the gain in CD4 lymphocyte count in subsequent intervals was lower than this, by 24 months on ART the median increase in CD4 lymphocyte count compared to baseline was 288 × 106 cells/l (95% CI, 181–470 × 106 cells/l), with a median absolute CD4 lymphocyte count at this duration on treatment of 323 × 106 cells/l.

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Regimen durability

The highest percentage of changes in regimen (Table 3) due to adverse events attributed to an individual antiretroviral was for nevirapine for which 8.8% (95% CI, 4.8–15.8%) (product-limit estimate) of patients had changed to efavirenz at 24 months. The equivalent percentage for zidovudine was 4.7% (95% CI, 2.6–8.0%) of patients changing to stavudine. No patients were changed from lamivudine for any agent-specific reason, and only two patients could not tolerate efavirenz. For all regimens combined, 8.4% (95% CI, 5.6–12.5%) of patients had an intolerance-driven change to their first regimen cumulatively by 24 months. Most changes occurred soon after treatment was started (median 42 days; IQR, 28–56 days). A further 10 patients switched from nevirapine to efavirenz due to a new episode of tuberculosis as efavirenz was the only non-nucleoside reverse transcriptase inhibitor recommended for co-administration with rifampicin, [15] and three patients from efavirenz to nevirapine due to pregnancy or a wish to become pregnant. Including these latter switches, 15.1% (95% CI, 10.7–21.1%) of patients on the first-line regimen had a regimen change due to adverse events or contraindications by 24 months. Twelve patients had changed the entire regimen due to treatment failure by the end of July 2003.

Table 3
Table 3
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Discussion

This analysis is limited by the short duration of follow-up and by the small numbers at risk in the analysis beyond 1 year on treatment. The early results of this programme are, however, comparable with data from observational settings in both developed and developing countries. This programme builds on results reported for other African settings in demonstrating the feasibility of successful ART programmes in these contexts [7,16]. In spite of differences in reporting, patients in Khayelitsha initiated therapy with more advanced disease than reported in Uganda [7] and Senegal, [16] and using survival as an endpoint, have responded to treatment at least as well, if not better. Furthermore, this programme represents one of the first attempts to integrate ART as part of a comprehensive government response to HIV/AIDS in a geographically-defined health district. Previous work in Cape Town indicates that median survival without ART for those with CD4 lymphocyte counts < 50 × 106 cells/l would be less than 12 months [17]. This highlights the likely benefit of the intervention in this population where the survival estimate for the same subgroup of patients at 12 months duration on ART was 81.8%.

Survival outcomes in this programme are comparable to those reported for patients initiating ART with very low CD4 lymphocyte counts in two observational studies in Canada and the USA [18]. Although the observation periods for these cohorts include years where dual therapy was provided, the point estimates of survival are very similar to those observed in Khayelitsha, ranging from 64.6% to 79.5% for those initiating treatment with CD4 lymphocyte counts < 50 × 106 cells/l, and from 78.1% to 90.0% for those initiating treatment with CD4 lymphocyte counts above this value. At 24 months duration on treatment the stratified survival estimates from Khayelitsha exceed the upper end of these ranges.

In many of those countries worst affected by the HIV pandemic, scarcity of resources and capacity will mean that not everyone with the potential to benefit from ART will be able to access it, with a tendency for the sickest patients to access treatment first. The difference in survival in the Khayelitsha cohort between those starting treatment with CD4 lymphocyte counts of 50 × 106 cells/l or more compared to the group with CD4 lymphocyte counts below this level, suggests that one of the major challenges in contexts such as Khayelitsha is to ensure a fair balance between providing access to ART for those presenting very late, whilst preserving the opportunity for a better prognosis for those who have enrolled in the programme in a timely manner. Given that survival in those presenting with CD4 lymphocyte counts < 50 × 106 cells/l is nevertheless markedly improved compared to the anticipated natural history, the programme does not consider CD4 lymphocyte count an exclusion to ART if the Karnofsky score is above 40%. It may in future be possible to identify strategies to further improve survival in this early period for those with extensive immune suppression at presentation.

The stratification of survival by a CD4 lymphocyte count of 50 × 106 cells/l was motivated by the potential to compare to other studies that have used these categories. However, the data suggested that the survival experience in this context would be more powerfully discriminated by a dichotomous categorization at a lower CD4 lymphocyte count.

The exploration of an association of a previous diagnosis of Kaposi's sarcoma (KS) with survival was prompted by reports of an association in other MSF projects. A mortality review suggested that in only three out of eight cases could the cause of death be directly linked to KS. Clinical details of the nature and extent of KS were not available. A more thorough exploration of this association is warranted as the numbers on treatment in the project increase. Although only three deaths were linked to new episodes of tuberculosis following initiation of ART, tuberculosis poses constant challenges in this setting. A full incidence study of tuberculosis prior to ART and on ART is currently underway. Innovative approaches to managing tuberculosis that extend beyond the provision of ART are urgently required. The occurrence of a number of deaths very soon after initiating treatment is most likely due to the extreme disease advancement of many patients by the time they were able to access treatment.

The high proportion of patients with HIV RNA measurements < 400 copies/ml in the first year on treatment further underpins the fact that adherence rates, comparable to those in rich countries, are achievable in resource-limited settings [19]. The proportions of patients with HIV RNA measurements < 400 copies/ml at various durations on treatment compare favourably with those reported in other African settings, [7,16] and are similar to those from rich countries in spite of differences in reporting [20–22]. CD4 lymphocyte count gains were impressive and are similar in magnitude at 1 year on treatment to those reported elsewhere, [23] in spite of the relatively late initiation of treatment.

Although this paper has not sought to explore the costs of treatment, at $60 (USD 1 = ZAR 8) per test, HIV RNA testing is a significant expense to the programme relative to drug costs. A generic triple-therapy regimen was being purchased at the end of 2002 for $1.08 per day. This highlights the importance of campaigning for lower prices of HIV RNA testing together with antiretroviral drugs, or of validating approaches that do not include HIV RNA testing.

Rates of treatment change due to adverse events were uniformly low, and comparable or lower than those published for other cohorts [24]. This is a reflection of the incidence of severe adverse events in general, and demonstrates that with standardized regimens, monitoring and clinical management algorithms as is the case in Khayelitsha, ART can be safely used in resource-constrained settings. The most common contraindication resulting in a treatment change was in patients who developed tuberculosis after starting ART and who were switched from nevirapine to efavirenz, due to concerns about the co-administration of nevirapine with rifampicin.

With the recent declaration by the WHO of the failure to deliver AIDS medicines to those who need them as a global health emergency, exploring the programme design choices that impact on clinical outcomes in developing countries is urgent. There are a number of important lessons emerging from this programme. Careful preparation of patients is essential, extending beyond applying clinical eligibility criteria. This, together with treatment in a primary care setting, and as part of an integrated package of services for HIV, maximizes the potential impact of treatment programmes. With a patient-centred approach and a strong support programme involving specifically trained lay counsellors and peer support mechanisms, good adherence to treatment is achievable. With support, nurses can diagnose and treat most opportunistic infections and deliver ART in line with standardized protocols.

Although there are a number of factors that have promoted programme success, including the involvement of an international NGO, most treatment advocates would envisage new resources accompanying the introduction of ART in resource-constrained settings. Khayelitsha represents one of the most marginalized urban communities in South Africa, with extensive co-morbidity and health-system challenges. These findings provide encouragement to those seeking to provide similar services in poor communities where HIV morbidity and mortality are high.

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Acknowledgements

We thank all patients, nurses, doctors, counsellors, treatment activists, researchers, officials and others who have supported the programme in Khayelitsha.

Sponsorship: Supported by the Department of Health of the Provincial Administration of the Western Cape and Médecins Sans Frontières. The university-affiliated authors are jointly funded by the University of Cape Town and the Provincial Administration of the Western Cape.

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International Journal of Tuberculosis and Lung Disease
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Zachariah, R; Fitzgerald, M; Massaquoi, M; Acabu, A; Chilomo, D; Salaniponi, FML; Harries, AD
International Journal of Tuberculosis and Lung Disease, 11(8): 848-853.

Journal of Infectious Diseases
Research for change: Using implementation research to strengthen HIV care and treatment scale-up in resource-limited settings
Hirschhorn, LR; Ojikutu, B; Rodriguez, W
Journal of Infectious Diseases, 196(): S516-S522.
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Archives of Internal Medicine
Effectiveness of antiretroviral treatment in a South African program - A cohort study
Fairall, LR; Bachmann, MO; Louwagie, GMC; van Vuuren, C; Chikobvu, P; Steyn, D; Staniland, GH; Timmerman, V; Msimanga, M; Seebregts, CJ; Boulle, A; Nhiwatiwa, R; Bateman, ED; Zwarenstein, MF; Chapman, RD
Archives of Internal Medicine, 168(1): 86-93.

Journal of Infectious Diseases
Scaling up antiretroviral therapy in South Africa: The impact of speed on survival
Walensky, RP; Wood, R; Weinstein, MC; Martinson, NA; Losina, E; Fofana, MO; Goldie, SJ; Divi, N; Yazdanpanah, Y; Wang, B; Paltiel, AD; Freedberg, KA
Journal of Infectious Diseases, 197(9): 1324-U23.
10.1086/587184
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Lancet Infectious Diseases
Virological follow-up of adult patients in antiretroviral treatment programmes in sub-Saharan Africa: a systematic review
Barth, RE; van der Loeff, MFS; Schuurman, R; Hoepelmon, AIM; Wensing, AMJ
Lancet Infectious Diseases, 10(3): 155-166.

Bulletin of the World Health Organization
Prevention and treatment of human immunodeficiency virus/acquired immunodeficiency syndrome in resource-limited settings
Hogan, DR; Salomon, JA
Bulletin of the World Health Organization, 83(2): 135-143.

Samj South African Medical Journal
Should we be initiating antiretroviral therapy earlier? An argument in favour
Wood, R
Samj South African Medical Journal, 95(): 926-+.

AIDS
Long-term survival and immuno-virological response of African HIV-1-infected children to highly active antiretroviral therapy regimens
Rouet, F; Fassinou, P; Inwoley, A; Anaky, MF; Kouakoussui, A; Rouzioux, C; Blanche, S; Msellati, P
AIDS, 20(): 2315-2319.

Tropical Medicine & International Health
Adherence to antiretroviral therapy in Africa: how high is it really?
Jaffar, S; Munderi, P; Grosskurth, H
Tropical Medicine & International Health, 13(9): 1096-1097.
10.1111/j.1365-3156.2008.02131.x
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European Journal of Clinical Microbiology & Infectious Diseases
Effectiveness of highly active antiretroviral therapy administered by general practitioners in rural South Africa
Barth, RE; van der Meer, JTM; Hoepelman, AIM; Schrooders, PA; van de Vijver, DA; Geelen, SPM; Tempelman, HA
European Journal of Clinical Microbiology & Infectious Diseases, 27(): 977-984.
10.1007/s10096-008-0534-2
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International Journal of Infectious Diseases
Validation of the Accutrend (R) lactate meter for hyperlactatemia screening during antiretroviral therapy in a resource-poor setting
Perez, EH; Dawood, H; Chetty, U; Esterhuizen, TM; Bizaare, M
International Journal of Infectious Diseases, 12(5): 553-556.
10.1016/j.ijid.2008.03.007
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AIDS Patient Care and Stds
Liver Enzymes Improve Over Twenty-Four Months of First-Line Non-Nucleoside Reverse Transcriptase Inhibitor-Based Therapy in Rural Uganda
Weidle, PJ; Moore, D; Mermin, J; Buchacz, K; Were, W; Downing, R; Kigozi, A; Ndazima, V; Peters, P; Brooks, JT
AIDS Patient Care and Stds, 22(): 787-795.
10.1089/apc.2008.0020
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Hiv Clinical Trials
Resistance and Virological Response Analyses in a Three Initial Treatment Strategy Trial: A Substudy of the INITIO Trial
Descamps, D; Chazallon, C; Loveday, C; Bacheler, L; Goodall, R; Yeni, P; Cooper, DA; Babiker, A; Aboulker, JP; Brun-Vezinet, F
Hiv Clinical Trials, 10(6): 385-393.
10.1310/hct1006-385
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Jama-Journal of the American Medical Association
Rapid scale-up of Antiretroviral therapy at primary care sites in Zambia - Feasibility and early outcomes
Stringer, JSA; Zulu, I; Levy, J; Stringer, EM; Mwango, A; Chi, BH; Mtonga, V; Reid, S; Cantrell, RA; Bulterys, M; Saag, MS; Marlink, RG; Mwinga, A; Ellerbrock, TV; Sinkala, M
Jama-Journal of the American Medical Association, 296(7): 782-793.

Jaids-Journal of Acquired Immune Deficiency Syndromes
Development and assessment of an innovative culturally sensitive educational Videotape to improve adherence to highly active antiretroviral therapy in Soweto, South Africa
Wong, IY; Lawrence, NV; Struthers, H; McIntyre, J; Friedland, GH
Jaids-Journal of Acquired Immune Deficiency Syndromes, 43(): S142-S148.

AIDS Research and Human Retroviruses
Consistent ART Adherence Is Associated with Improved Quality of Life, CD4 Counts, and Reduced Hospital Costs in Central China
Wang, HH; Zhou, J; He, GP; Luo, Y; Li, XH; Yang, AY; Fennie, K; Williams, AB
AIDS Research and Human Retroviruses, 25(8): 757-763.
10.1089/aid.2008.0173
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AIDS Research and Human Retroviruses
Medium-Term Probability of Success of Antiretroviral Treatment after Early Warning Signs of Treatment Failure in West African Adults
Danel, C; Gabillard, D; Inwoley, A; Chaix, ML; Toni, TD; Moh, R; Messou, E; Bissagnene, E; Salamon, R; Eholie, S; Anglaret, X
AIDS Research and Human Retroviruses, 25(8): 783-793.
10.1089/aid.2009.0018
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AIDS
Non-nucleoside reverse transcriptase inhibitor outcomes among combination antiretroviral therapy-treated adults in Botswana
Wester, CW; Thomas, AM; Bussmann, H; Moyo, S; Makhema, JM; Gaolathe, T; Novitsky, V; Essex, M; deGruttola, V; Marlink, RG
AIDS, 24(): S27-S36.

Culture Health & Sexuality
Sex after ART: sexual partnerships established by HIV-infected persons taking anti-retroviral therapy in Eastern Uganda
Seeley, J; Russell, S; Khana, K; Ezati, E; King, R; Bunnell, R
Culture Health & Sexuality, 11(7): 703-716.
10.1080/13691050903003897
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AIDS Reviews
First-line antiretroviral therapy in Africa - How evidence-based are our recommendations?
Colebunders, R; Kamya, MR; Laurence, J; Kambugu, A; Byakwaga, H; Mwebaze, PS; Muganga, AM; Katwere, M; Katabira, E
AIDS Reviews, 7(3): 148-154.

AIDS
Early mortality among adults accessing a community-based antiretroviral service in South Africa: implications for programme design
Lawn, SD; Myer, L; Orrell, C; Bekker, LG; Wood, R
AIDS, 19(): 2141-2148.

Brazilian Journal of Medical and Biological Research
Effectiveness of highly active antiretroviral therapy using non-brand name drugs in Brazil
May, SB; Barroso, PF; Nunes, EP; Barcaui, HS; Almeida, MMT; Costa, MD; Faulhaber, JC; Santoro-Lopes, G; Schechter, M
Brazilian Journal of Medical and Biological Research, 40(4): 551-555.

AIDS
Positive outcomes of HAART at 24 months in HIV-infected patients in Cambodia
Ferradini, L; Laureillard, D; Prak, N; Ngeth, C; Fernandez, M; Pinoges, L; Puertas, G; Taburet, AM; Ly, N; Rouzioux, C; Balkan, S; Quillet, C; Delfraissy, JF
AIDS, 21(): 2293-2301.

Tropical Medicine & International Health
Polymorphisms in HIV-I subtype C proteases and the potential impact on protease inhibitors
Bessong, PO
Tropical Medicine & International Health, 13(2): 144-151.
10.1111/j.1365-3156.2007.01984.x
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Bulletin of the World Health Organization
New methods for estimating the tuberculosis case detection rate in high-HIV prevalence countries: the example of Kenya
Mansoer, J; Scheele, S; Floyd, K; Dye, C; Sitienei, J; Williams, B
Bulletin of the World Health Organization, 87(3): 186-192.
10.2471/BLT.08.051474
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Tropical Medicine & International Health
Very early mortality in patients starting antiretroviral treatment at primary health centres in rural Malawi
Zachariah, R; Harries, K; Moses, M; Manzi, M; Line, A; Mwagomba, B; Harries, AD
Tropical Medicine & International Health, 14(7): 713-721.
10.1111/j.1365-3156.2009.02291.x
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Annals of Internal Medicine
Five-Year Outcomes of the China National Free Antiretroviral Treatment Program
Zhang, FJ; Dou, ZH; Ma, Y; Zhao, Y; Liu, ZF; Bulterys, M; Chen, RY
Annals of Internal Medicine, 151(4): 241-W52.

AIDS and Behavior
AIDS Denialism and Public Health Practice
Chigwedere, P; Essex, M
AIDS and Behavior, 14(2): 237-247.
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Lancet
Effectiveness and safety of a generic fixed-dose combination of nevirapine, stavudine, and lamivudine in HIV-1-infected adults in Cameroon: open-label multicentre trial
Laurent, C; Kouanfack, C; Koulla-Shiro, S; Nkoue, N; Bourgeois, A; Calmy, A; Lactuock, B; Nzeusseu, V; Mougnutou, R; Peytavin, G; Liegeois, F; Nerrienet, E; Tardy, M; Peeters, M; Andrieux-Meyer, I; Zekeng, L; Kazatchkine, M; Mpoudi-Ngole, E; Delaporte, E
Lancet, 364(): 29-34.

Hiv Clinical Trials
Antiretroviral treatment in correctional facilities
Pontali, E
Hiv Clinical Trials, 6(1): 25-37.

American Journal of Public Health
Antiretroviral therapy in resource-poor countries: Illusions and realities
Desvarieux, M; Landman, R; Liautaud, B; Girard, PM
American Journal of Public Health, 95(7): 1117-1122.
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Current Hiv Research
The unique features of pediatric HIV-1 in sub-Saharan Africa
De Baets, AJ; Ramet, J; Msellati, P; Lepage, P
Current Hiv Research, 6(4): 351-362.

Tropical Medicine & International Health
Reduced morbidity and mortality in the first year after initiating highly active anti-retroviral therapy (HAART) among Ugandan adults
Miiro, G; Todd, J; Mpendo, J; Watera, C; Munderi, P; Nakubulwa, S; Kaddu, I; Rutebarika, D; Grosskurth, H
Tropical Medicine & International Health, 14(5): 556-563.
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Plos One
Monitoring Virologic Responses to Antiretroviral Therapy in HIV-Infected Adults in Kenya: Evaluation of a Low-Cost Viral Load Assay
Sivapalasingam, S; Wangechi, B; Marshed, F; Laverty, M; Essajee, S; Holzman, RS; Valentine, F
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AIDS Research and Human Retroviruses
Tolerability and effectiveness of first-line regimens combining Nevirapine and lamivudine plus zidovudine or Stavudine in Cameroon
Laurent, C; Bourgeois, A; Mpoudi-Ngole, E; Ciaffi, L; Kouanfack, C; Mougnutou, R; Nkoue, N; Calmy, A; Koulla-Shiro, S; Delaporte, E
AIDS Research and Human Retroviruses, 24(3): 393-399.
10.1089/aid.2007.0219
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Postgraduate Medical Journal
Scaling up antiretroviral therapy in developing countries: what are the benefits and challenges?
Boulle, A; Ford, N
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10.1136/sti.2007.027748
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Transactions of the Royal Society of Tropical Medicine and Hygiene
Mortality and loss to follow-up among HAART initiators in rural South Africa
MacPherson, P; Moshabela, M; Martinson, N; Pronyk, P
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10.1016/j.trstmh.2008.10.001
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Clinical Infectious Diseases
Establishment of a public antiretroviral treatment clinic for adults in urban Botswana: Lessons learned
Wester, CW; Bussmann, H; Avalos, A; Ndwapi, N; Gaolathe, T; Cardiello, P; Bussmann, C; Moffat, H; Mazonde, P; Marlink, RG
Clinical Infectious Diseases, 40(7): 1041-1044.

AIDS Patient Care and Stds
Barriers to accessing antiretroviral therapy in Kisesa, Tanzania: A qualitative study of early rural referrals to the national program
Mshana, GH; Wamoyi, J; Busza, J; Zaba, B; Changalucha, J; Kaluvya, S; Urassa, M
AIDS Patient Care and Stds, 20(9): 649-657.

AIDS
Risk factors for high early mortality in patients on antiretroviral treatment in a rural district of Malawi
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AIDS, 20(): 2355-2360.

Social Science & Medicine
Hope is the pillar of the universe: Health-care providers' experiences of delivering anti-retroviral therapy in primary health-care clinics in the Free State province of South Africa
Stein, J; Lewin, S; Fairall, L
Social Science & Medicine, 64(4): 954-964.
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Clinical Infectious Diseases
Clinical, immunological, and epidemiological importance of antituberculosis T cell responses in HIV-infected Africans
Rangaka, MX; Diwakar, L; Seldon, R; van Cutsem, G; Meintjes, GA; Morroni, C; Mouton, P; Shey, MS; Maartens, G; Wilkinson, KA; Wilkinson, RJ
Clinical Infectious Diseases, 44(): 1639-1646.
10.1086/518234
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AIDS Research and Human Retroviruses
Morbidity before and after HAART initiation in sub-Saharan African HIV-infected adults: A recurrent event analysis
Seyler, C; Messou, E; Gabillard, D; Inwoley, A; Alioum, A; Anglaret, X
AIDS Research and Human Retroviruses, 23(): 1338-1347.
10.1089/aid.2006.0308
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International Journal of Std & AIDS
Correlates of HIV-1 viral suppression in a cohort of HIV-positive drug users receiving antiretroviral therapy in Hanoi, Vietnam
Jordan, MR; La, H; Nguyen, HD; Sheehan, H; Lien, TTM; Duong, DV; Hellinger, J; Wanke, C; Tang, AM
International Journal of Std & AIDS, 20(6): 418-422.
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Lancet
PEPFAR's biggest success is also its largest liability
Navario, P
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Bmc Infectious Diseases
Virological efficacy and emergence of drug resistance in adults on antiretroviral treatment in rural Tanzania
Johannessen, A; Naman, E; Kivuyo, SL; Kasubi, MJ; Holberg-Petersen, M; Matee, MI; Gundersen, SG; Bruun, JN
Bmc Infectious Diseases, 9(): -.
ARTN 108
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Lancet
Rates of virological failure in patients treated in a home-based versus a facility-based HIV-care model in Jinja, southeast Uganda: a cluster-randomised equivalence trial
Jaffar, S; Amuron, B; Foster, S; Birungi, J; Levin, J; Namara, G; Nabiryo, C; Ndembi, N; Kyomuhangi, R; Opio, A; Bunnell, R; Tappero, JW; Mermin, J; Coutinho, A; Grosskurth, H
Lancet, 374(): 2080-2089.
10.1016/S0140-6736(09)61674-3
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Tropical Medicine & International Health
Patient retention in antiretroviral therapy programs up to three years on treatment in sub-Saharan Africa, 2007-2009: systematic review
Fox, MP; Rosen, S
Tropical Medicine & International Health, 15(): 1-15.
10.1111/j.1365-3156.2010.02508.x
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Plos One
Early Adherence to Antiretroviral Medication as a Predictor of Long-Term HIV Virological Auppression: Five-Year Follow Up of an Observational Cohort
Ford, N; Darder, M; Spelman, T; Maclean, E; Mills, E; Boulle, A
Plos One, 5(5): -.
ARTN e10460
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Bmc Infectious Diseases
Predictors of mortality in HIV-infected patients starting antiretroviral therapy in a rural hospital in Tanzania
Johannessen, A; Naman, E; Ngowi, BJ; Sandvik, L; Matee, MI; Aglen, HE; Gundersen, SG; Bruun, JN
Bmc Infectious Diseases, 8(): -.
ARTN 52
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Sexually Transmitted Infections
The Spectrum projection package: improvements in estimating mortality, ART needs, PMTCT impact and uncertainty bounds
Stover, J; Johnson, P; Zaba, B; Zwahlen, M; Dabis, F; Ekpini, RE
Sexually Transmitted Infections, 84(): I24-I30.
10.1136/sti.2008.029868
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AIDS
Differences in normal activities, job performance and symptom prevalence between patients not yet on antiretroviral therapy and patients initiating therapy in South Africa
Rosen, S; Kethapile, M; Sanne, I; DeSilva, MB
AIDS, 22(): S131-S139.

Feminist Economics
Gender and Access to Antiretroviral Treatment in South Africa
Nattrass, N
Feminist Economics, 14(4): 19-36.
10.1080/13545700802266452
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Chest
Changing Global Epidemiology of Pulmonary Manifestations of HIV/AIDS
Hull, MW; Phillips, P; Montaner, JSG
Chest, 134(6): 1287-1298.
10.1378/chest.08-0364
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Health Policy and Planning
Determinants of non-adherence to subsidized anti-retroviral treatment in southeast Nigeria
Uzochukwu, BSC; Onwujekwe, OE; Onoka, AC; Okoli, C; Uguru, NP; Chukwuogo, OI
Health Policy and Planning, 24(3): 189-196.
10.1093/heapol/czp006
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Lancet
Palliative care in sub-Saharan Africa
Colebunders, R; John, L; Muganzi, A; Lynen, L; Kambugu, A
Lancet, 366(): 546-547.

New England Journal of Medicine
Scaling up treatment - Why we can't wait
Kim, JY; Gilks, C
New England Journal of Medicine, 353(): 2392-2394.

Clinical and Vaccine Immunology
Enhanced ex vivo stimulation of Mycobacterium tuberculosis-specific T cells in human immunodeficiency virus-infected persons via antigen delivery by the Bordetella pertussis adenylate cyclase vector
Connell, TG; Shey, MS; Seldon, R; Rangaka, MX; van Cutsem, G; Simsova, M; Marcekova, Z; Sebo, P; Curtis, N; Diwakar, L; Meintjes, GA; Leclerc, C; Wilkinson, RJ; Wilkinson, KA
Clinical and Vaccine Immunology, 14(7): 847-854.
10.1128/CVI.00041-07
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International Journal of Epidemiology
Cohort profile: Caribbean, Central and South America Network for HIV research (CCASAnet) collaboration within the International Epidemiologic Databases to Evaluate AIDS (IeDEA) programme
McGowan, CC; Cahn, P; Gotuzzo, E; Padgett, D; Pape, JW; Wolff, M; Schechter, M; Masys, DR
International Journal of Epidemiology, 36(5): 969-976.
10.1093/ije/dym073
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Sexually Transmitted Infections
Scaling up antiretroviral therapy in developing countries: what are the benefits and challenges?
Boulle, A; Ford, N
Sexually Transmitted Infections, 83(7): 503-505.
10.1136/sti.2007.027748
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European Journal of Clinical Pharmacology
High prevalence of the CYP2B6 516G -> T(*6) variant and effect on the population pharmacokinetics of efavirenz in HIV/AIDS outpatients in Zimbabwe
Nyakutira, C; Roshammar, D; Chigutsa, E; Chonzi, P; Ashton, M; Nhachi, C; Masimirembwa, C
European Journal of Clinical Pharmacology, 64(4): 357-365.
10.1007/s00228-007-0412-3
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Social Science & Medicine
"Conditional scholarships" for HIV/AIDS health workers: Educating and retaining the workforce to provide antiretroviral treatment in sub-Saharan Africa
Barnighausen, T; Bloom, DE
Social Science & Medicine, 68(3): 544-551.
10.1016/j.socscimed.2008.11.009
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American Journal of Tropical Medicine and Hygiene
High Early Mortality in Patients with Chronic Acquired Immunodeficiency Syndrome Diarrhea Initiating Antiretroviral Therapy in Haiti: A Case-Control Study
Dillingham, RA; Pinkerton, R; Leger, P; Severe, P; Guerrant, RL; Pape, JW; Fitzgerald, DW
American Journal of Tropical Medicine and Hygiene, 80(6): 1060-1064.

Current Hiv Research
Impact of Prior HAART Use on Clinical Outcomes in a Large Kenyan HIV Treatment Program
Chung, MH; Drake, AL; Richardson, BA; Reddy, A; Thiga, J; Sakr, SR; Kiarie, JN; Yowakim, P; John-Stewart, GC
Current Hiv Research, 7(4): 441-446.

Samj South African Medical Journal
Estimation of adult antiretroviral treatment coverage in South Africa
Adam, MA; Johnson, LF
Samj South African Medical Journal, 99(9): 661-667.

Hiv Clinical Trials
Delay between first HIV-related symptoms and diagnosis of HIV infection in patients attending the Internal Medicine Department of the Fondation Jeanne Ebori (FJE), Libreville, Gabon
Okome-Nkoumou, M; Okome-Miame, F; Kendjo, E; Obiang, GP; Kouna, P; Essola-Biba, O; Boguikouma, JB; Mboussou, M; Clevenbergh, P
Hiv Clinical Trials, 6(1): 38-42.

Clinical Infectious Diseases
Lessons learned from use of highly active antiretroviral therapy in Africa
Akileswaran, C; Lurie, MN; Flanigan, TP; Mayer, KH
Clinical Infectious Diseases, 41(3): 376-385.

Plos One
A Cluster Randomized Trial of Routine HIV-1 Viral Load Monitoring in Zambia: Study Design, Implementation, and Baseline Cohort Characteristics
Koethe, JR; Westfall, AO; Luhanga, DK; Clark, GM; Goldman, JD; Mulenga, PL; Cantrell, RA; Chi, BH; Zulu, I; Saag, MS; Stringer, JSA
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Journal of Infectious Diseases
The extraordinary hope of Antiretroviral therapy in South Africa (even for patients with tuberculosis or Kaposi sarcoma!)
Flanigan, TP; Campbell, T; Harwell, J; Kumarasamy, N
Journal of Infectious Diseases, 191(3): 321-323.

Transactions of the Royal Society of Tropical Medicine and Hygiene
Targeting CD4 testing to a clinical subgroup of patients could limit unnecessary CD4 measurements, premature antiretroviral treatment and costs in Thyolo District, Malawi
Zachariah, R; Teck, R; Ascurra, O; Humblet, P; Harries, AD
Transactions of the Royal Society of Tropical Medicine and Hygiene, 100(1): 24-31.
10.1016/j.trstmh.2005.06.018
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Reproductive Health Matters
Health systems and access to antiretroviral drugs for HIV in southern Africa: Service delivery and human resources challenges
Schneider, H; Blaauw, D; Gilson, L; Chabikuli, N; Goudge, J
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Jama-Journal of the American Medical Association
Outcomes of nevirapine- and efavirenz-based antiretroviral therapy when coadministered with rifampicin-based antitubercular therapy
Boulle, A; Van Cutsem, G; Cohen, K; Hilderbrand, K; Mathee, S; Abrahams, M; Goemaere, E; Coetzee, D; Maartens, G
Jama-Journal of the American Medical Association, 300(5): 530-539.

Tropical Medicine & International Health
Determinants of survival in AIDS patients on antiretroviral therapy in a rural centre in the Far-North Province, Cameroon
Sieleunou, I; Souleymanou, M; Schonenberger, AM; Menten, J; Boelaert, M
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Tropical Medicine & International Health
Vital status of pre-ART and ART patients defaulting from care in rural Malawi
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Samj South African Medical Journal
The failure of HIV prevention is South Africa's biggest health crisis
Venter, WDF
Samj South African Medical Journal, 96(4): 298-+.

AIDS
Incidence and determinants of mortality and morbidity following early antiretroviral therapy initiation in HIV-infected adults in West Africa
Moh, R; Danel, C; Messou, E; Cluassa, T; Gabillard, D; Anzian, A; Abo, Y; Salamon, R; Bissagnene, E; Seyler, C; Eholie, S; Anglaret, X
AIDS, 21(): 2483-2491.

Archives of Internal Medicine
Cost-effectiveness of HIV monitoring strategies in resource-limited settings - A Southern African analysis
Bendavid, E; Young, SD; Katzenstein, DA; Bayoumi, AM; Sanders, GD; Owens, DK
Archives of Internal Medicine, 168(): 1910-1918.

Gynecologic Oncology
Cost effectiveness of high-risk HPV DNA testing for cervical cancer screening in South Africa
Vijayaraghavan, A; Efrusy, M; Lindeque, G; Dreyer, G; Santas, C
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Social Science & Medicine
Stigma rises despite antiretroviral roll-out: A longitudinal analysis in South Africa
Maughan-Brown, B
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American Journal of Obstetrics and Gynecology
Prevention of mother-to-child transmission services as a gateway to family-based human immunodeficiency virus care and treatment in resource-limited settings: rationale and international experiences
Abrams, EJ; Myer, L; Rosenfield, A; El-Sadr, WM
American Journal of Obstetrics and Gynecology, 197(3): S101-S106.
10.1016/j.ajog.2007.03.068
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Tropical Medicine & International Health
Increased mortality of male adults with AIDS related to poor compliance to antiretroviral therapy in Malawi
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Lancet
Outcomes from monitoring of patients on antiretroviral therapy in resource-limited settings with viral load, CD4 cell count, or clinical observation alone: a computer simulation model
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Journal of Human Resources
The economic impact of AIDS treatment - Labor supply in Western Kenya
Thirumurthy, H; Zivin, JG; Goldstein, M
Journal of Human Resources, 43(3): 511-552.

Tropical Medicine & International Health
The outcomes and outpatient costs of different models of antiretroviral treatment delivery in South Africa
Rosen, S; Long, L; Sanne, I
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Journal of Palliative Medicine
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Southern African Journal of Hiv Medicine
Held to Ransom - Cmv Treatment in South Africa
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Antiviral Therapy
Field assessment of generic antiretroviral drugs: a prospective cohort study in Cameroon
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Presse Medicale
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Lancet
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Bulletin of the World Health Organization
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Acta Paediatrica
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Plos Medicine
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Bmc Infectious Diseases
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Annals of Internal Medicine
When to Start Antiretroviral Therapy in Resource-Limited Settings
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Clinical Infectious Diseases
Macronutrient Supplementation for Malnourished HIV-Infected Adults: A Review of the Evidence in Resource-Adequate and Resource-Constrained Settings
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Bmc Pediatrics
Excellent outcomes among HIV plus children on ART, but unacceptably high pre-ART mortality and losses to follow-up: a cohort study from Cambodia
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American Journal of Tropical Medicine and Hygiene
Methods and Baseline Results of a Repeated Cross-Sectional Survey to Assess the Public Health Impact of Antiretroviral Therapy in Lusaka, Zambia
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Journal of Urban Health-Bulletin of the New York Academy of Medicine
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Nature
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Reproductive Health Matters
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European Journal of Epidemiology
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Antiviral Therapy
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Antiviral Therapy, 13(): 15-23.

Revue De Medecine Interne
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Plos Medicine
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Sajog-South African Journal of Obstetrics and Gynaecology
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Samj South African Medical Journal
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Current Hiv Research
Long-Term CD4 Cell Count Recovery among Thai Naive HIV-Infected Patients Initiating HAART at Low CD4 Cell Count
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Clinical Infectious Diseases
Cause-Specific Mortality and the Contribution of Immune Reconstitution Inflammatory Syndrome in the First 3 Years after Antiretroviral Therapy Initiation in an Urban African Cohort
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Hiv Medicine
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Hiv Medicine, 7(2): 99-104.

Lancet
Mortality of HIV-1-infected patients in the first year of antiretroviral therapy: comparison between low-income and high-income countries
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International Journal of Epidemiology
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British Medical Journal
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Antiviral Therapy
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Antiviral Therapy, 12(5): 753-760.

Bulletin of the World Health Organization
Offering integrated care for HIVAIDS, diabetes and hypertension within chronic disease clinics in Cambodia
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American Journal of Respiratory and Critical Care Medicine
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Estimating the Capacity for ART Provision in Tanzania with the Use of Data on Staff Productivity and Patient Losses
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Canadian Journal of Public Health-Revue Canadienne De Sante Publique
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Bmc Infectious Diseases
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Ajar-African Journal of AIDS Research
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Clinical Infectious Diseases
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Current Hiv Research
Results of a Community-Based Antiretroviral Treatment Program for HIV-1 Infection in Western Uganda
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International Journal of Epidemiology
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Annals of Tropical Medicine and Parasitology
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AIDS Care-Psychological and Socio-Medical Aspects of AIDS/Hiv
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Charalambous, S; Grant, AD; Day, JH; Pemba, L; Chaisson, RE; Kruger, P; Martin, D; Wood, R; Brink, B; Churchyard, GJ
AIDS Care-Psychological and Socio-Medical Aspects of AIDS/Hiv, 19(1): 34-41.
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Antiviral Therapy
Conservation of first-line antiretroviral treatment regimen where therapeutic options are limited
Orrell, C; Harling, G; Lawn, SD; Kaplan, R; McNally, M; Bekker, LG; Wood, R
Antiviral Therapy, 12(1): 83-88.

Journal of Infectious Diseases
Making universal access a reality - What more do we need to know?
Hirschhorn, LR; Skolnik, R
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AIDS Patient Care and Stds
Spectrum of adverse events after generic HAART in southern Indian HIV-infected patients
Kumarasamy, N; Venkatesh, KK; Cecelia, AJ; Devaleenal, B; Lai, AR; Saghayam, S; Balakrishnan, P; Yepthomi, T; Poongulali, S; Flanigan, TP; Solomon, S; Mayer, KH
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Antiviral Therapy
The World Health Organization's global strategy for prevention and assessment of HIV drug resistance
Bennett, DE; Bertagnolio, S; Sutherland, D; Gilks, CF
Antiviral Therapy, 13(): 1-13.

Samj South African Medical Journal
Availability of antiretroviral therapy is associated with increased uptake of HIV testing services
Mfundisi, C; Chiranjan, N; Rodrigues, C; Kirchner, L; Bock, P; Myer, L
Samj South African Medical Journal, 95(7): 483-485.

Antiviral Therapy
Haematological changes in adults receiving a zidovudine-containing HAART regimen in combination with cotrimoxazole in Cote d'Ivoire
Moh, R; Danel, C; Sorho, S; Sauvageot, D; Anzian, A; Minga, A; Gomis, OB; Kanga, C; Inwoley, A; Gabillard, D; Bissagnene, E; Salamon, R; Anglaret, X
Antiviral Therapy, 10(5): 615-624.

Samj South African Medical Journal
Rapid scale-up of a community-based HIV treatment service - Programme performance over 3 consecutive years in Guguletu, South Africa
Bekker, LG; Myer, L; Orrell, C; Lawn, S; Wood, R
Samj South African Medical Journal, 96(4): 315-320.

Lancet
Scaling up of highly active antiretroviral therapy in a rural district of Malawi: an effectiveness assessment
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Lancet
Fight AIDS as well as the brain drain
Feeley, F
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Clinical Infectious Diseases
Determinants of mortality and nondeath losses from an antiretroviral treatment service in South Africa: Implications for program evaluation
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Clinical Infectious Diseases, 43(6): 770-776.

Hiv Medicine
Efavirenz replacement by immediate full-dose nevirapine is safe in HIV-1-infected patients in Cambodia
Laureillard, D; Prak, N; Fernandez, M; Ngeth, C; Moeung, S; Riel, V; Chhneang, V; Song, S; Quillet, C; Piketty, C
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Clinical Infectious Diseases
The effect of highly active antiretroviral therapy on mortality among HIV-infected former plasma donors in China
Zhang, FJ; Dou, ZH; Yu, L; Xu, JH; Jiao, JH; Wang, N; Ma, Y; Zhao, Y; Zhao, HX; Chen, RY
Clinical Infectious Diseases, 47(6): 825-833.
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Antiviral Therapy
Severe hyperlactataemia complicating stavudine first-line antiretroviral therapy in South Africa
Stead, D; Osler, M; Boulle, A; Rebe, K; Meintjes, G
Antiviral Therapy, 13(7): 937-943.

Jaids-Journal of Acquired Immune Deficiency Syndromes
Gender, Empowerment, and Health: What Is It? How Does It Work?
Ehrhardt, AA; Sawires, S; McGovern, T; Peacock, D; Weston, M
Jaids-Journal of Acquired Immune Deficiency Syndromes, 51(): S96-S105.

Jaids-Journal of Acquired Immune Deficiency Syndromes
Men, HIV/AIDS, and Human Rights
Peacock, D; Stemple, L; Sawires, S; Coates, TJ
Jaids-Journal of Acquired Immune Deficiency Syndromes, 51(): S119-S125.

Plos One
Mortality Reduction Associated with HIV/AIDS Care and Antiretroviral Treatment in Rural Malawi: Evidence from Registers, Coffin Sales and Funerals
Mwagomba, B; Zachariah, R; Massaquoi, M; Misindi, D; Manzi, M; Mandere, BC; Bemelmans, M; Philips, M; Kamoto, K; Schouten, EJ; Harries, AD
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AIDS Research and Human Retroviruses
Resistance mutational analysis of HIV type 1 subtype C among rural South African drug-naive patients prior to large-scale availability of antiretrovirals
Bessong, PO; Mphahlele, J; Choge, IA; Obi, LC; Morris, L; Hammarskjold, ML; Rekosh, DM
AIDS Research and Human Retroviruses, 22(): 1306-1312.

Hiv Medicine
Prior antiretroviral therapy experience protects against zidovudine-related anaemia
Huffam, SE; Srasuebkul, P; Zhou, J; Calmy, A; Saphonn, V; Kaldor, J; Ditangco, R
Hiv Medicine, 8(7): 465-471.

AIDS
Scale-up of HIV care and treatment: can it transform healthcare services in resource-limited settings?
El-Sadr, WM; Abrams, EJ
AIDS, 21(): S65-S70.

Tropical Medicine & International Health
Antiretroviral therapy in resource-limited settings 1996 to 2006: patient characteristics, treatment regimens and monitoring in sub-Saharan Africa, Asia and Latin America
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South African Journal of Economics
The impact of highly active antiretroviral treatment (HAART) on employment in Khayelitsha
Coetzee, C
South African Journal of Economics, 76(): S75-S85.

Lancet Infectious Diseases
Tuberculosis-associated immune reconstitution inflammatory syndrome: case definitions for use in resource-limited settings
Meintjes, G; Lawn, SD; Scono, F; Moartens, G; French, MA; Worodria, W; Elliott, JH; Murdoch, D; Wilkinson, RJ; Seyler, C; John, L; van der Loeff, MS; Reiss, P; Lynen, L; Janoff, EN; Gilks, C; Colebunders, R
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AIDS Research and Human Retroviruses
Patients with Advanced HIV Type 1 Infection Initiating Antiretroviral Therapy in Botswana: Treatment Response and Mortality
Mujugira, A; Wester, CW; Kim, S; Bussmann, H; Gaolathe, T
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Social Science & Medicine
Public-sector ART in the Free State Province, South Africa: Community support as an important determinant of outcome
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American Journal of Clinical Nutrition
Nutritional aspects of HIV-associated wasting in sub-Saharan Africa
Koethe, JR; Heimburger, DC
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Plos One
A National Survey of Teachers on Antiretroviral Therapy in Malawi: Access, Retention in Therapy and Survival
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Dermatologic Clinics
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Lancet
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Weidle, PJ; Wamai, N; Solberg, P; Liechty, C; Sendagala, S; Were, W; Mermin, J; Buchacz, K; Behumbiize, P; Ransom, RL; Bunnell, R
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Clinical Infectious Diseases
Optimizing treatment for HIV-infected South African women exposed to single-dose nevirapine: Balancing efficacy and cost
Holmes, CB; Zheng, H; Martinson, NA; Freedberg, KA; Walensky, RP
Clinical Infectious Diseases, 42(): 1772-1780.

American Journal of Respiratory and Critical Care Medicine
Effect of HIV-1 infection on T-cell-based and skin test detection of tuberculosis infection
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Clinical Infectious Diseases
Adherence to antiretroviral therapy and virologic suppression among HIV-infected persons receiving care in private clinics in Mumbai, India
Shah, B; Walshe, L; Saple, DG; Mehta, SH; Ramnani, JP; Kharkar, RD; Bollinger, RC; Gupta, A
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AIDS Care-Psychological and Socio-Medical Aspects of AIDS/Hiv
Exploring HIV risk perception and behaviour in the context of antiretroviral treatment: results from a township household survey
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Plos One
Overestimates of Survival after HAART: Implications for Global Scale-Up Efforts
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Malawi Medical Journal
HIV Testing and Antiretroviral Therapy in Government and Mission Hospitals in Malawi: 2002-2007
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AIDS
Evaluating the impact of antiretroviral therapy on HIV transmission
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Bulletin of the World Health Organization
Antiretroviral therapy and early morality in South Africa
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Plos Medicine
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Tropical Medicine & International Health
Using vital registration data to update mortality among patients lost to follow-up from ART programmes: evidence from the Themba Lethu Clinic, South Africa
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Lancet
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Clinical Infectious Diseases
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Keywords:

antiretroviral therapy; primary care; CD4 cell count; HIV RNA viral load; South Africa

© 2004 Lippincott Williams & Wilkins, Inc.

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