[701] EARLY OUTCOMES AND LESSONS FROM A PUBLIC SECTOR ANTIRETROVIRAL TREATMENT PROGRAMME IN SOUTH AFRICA

2nd International AIDS Society Conference on HIV Pathogenesis and Treatment

Paris, France - July 13 - 16, 2003

[TITLE:] EARLY OUTCOMES AND LESSONS FROM A PUBLIC SECTOR ANTIRETROVIRAL TREATMENT PROGRAMME IN SOUTH AFRICA

[AUTHOR(S):] A Boulle¹, D Coetzee¹, K Hildebrand², E Goemaere³ and H Reuter³
¹Infectious Diseases Epidemiology Unit, Department of Public Health and Family Medicine, University of Cape Town, South Africa; ²Institute of Tropical Medicine, Brussels, Antwerp; and 3 Médecins Sans Frontières, Cape Town, South Africa

IAS Conf HIV Pathog Treat 2003 Jul 13-16;2nd: Abstract No. 701
Antiviral Therapy 2003; 8(Suppl. 1):S378

[ABSTRACT:] Khayelitsha is a township on the outskirts of Cape Town. The prevalence of HIV among antenatal clinic attenders was 21% in 2001. A collaboration between the provincial government and an international NGO has seen the establishment of an antiretroviral treatment programme in 3 primary care facilities in Khayelitsha. The first patients began treatment in May 2001. Clinical outcomes have been prospectively monitored since inception. Included outcomes include survival, CD4 cell count changes, changes in viral load, regimen and individual drug durability, and incidence of opportunistic infections. Survival analyses and modelling were performed using non-parametric methods and Cox proportional hazards regression. By the end of 2002, 288 adults naïve to prior antiretroviral treatment had started treatment. Patients to date have initiated treatment very late (median CD4 cell count less than 50 cells/µl), with a product limit estimate of survival at 18 months of 85%. A CD4 cell count on initiation of treatment equal to or below 15 cells/µl significant differentiated survival outcomes. The incidence of new cases of tuberculosis declined by twothirds after initiation of antiretroviral treatment. Results for these and additional outcome measures up until 18 months duration on treatment will be presented together with an overview of success factors and limitations in programme design and implementation. The results demonstrate the feasibility of antiretroviral treatment in this primary care setting, with relevance to similar settings in South Africa and the region. Important lessons are emerging with respect to the selection of patients to receive treatment, clinical monitoring, and programme implementation.

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