AEGiS-15IAC: Implications of selection criteria for antiretroviral therapy in South Africa.

15th International AIDS Conference

Bangkok, Thailand - July 11-16, 2004

Implications of selection criteria for antiretroviral therapy in South Africa.

Int Conf AIDS 2004 Jul 11-16; 15:(abstract no. MoOrB1080)

Hausler H, Naidoo P, Schoeman H, Karpakis B, Godfrey-Faussett P
London School of Hygiene and Tropical Medicine, University of Cape Town, Cape Town, South Africa

BACKGROUND: Central District is 1 of 4 TB/HIV Pilot Districts established by South Africa in 1999 with WHO's ProTEST Initiative. A plan to provide antiretroviral therapy (ART) was approved by government in November 2003. South Africa has followed WHO's. recommendations that people with CD4<200 or WHO stage 4 are eligible for ART.

METHODS: Voluntary HIV counseling and testing was available for all attenders in two primary health care facilities and encouraged in TB, STI and antenatal patients. From the period April to December 2000, HIV-positive clients were clinically staged, screened for tuberculosis (TB) and had CD4 lymphocyte counts as screening for HIV care.

RESULTS: Of 343 HIV-positive clients, 313 (91%) had CD4 counts as well as WHO clinical staging and were included in the analysis. Of these, 41% were men. Compared to women, men were older (34 vs 29 years) were more likely to be in stage 4 (17% vs 9%) or have CD4<200 (38% vs 24%). The mean CD4 for each clinical stage was as follows- 1: 440±222/mL, 2: 369±266/mL, 3: 262±209/mL, 4: 179±150/mL. Of all HIV-positive people screened, 111 (35%) were either stage 4 or had CD4<200 and would be eligible for ART. Of these, 18 (16%) were stage 4 with CD4>=200. Among those eligible for ART, 53% were men with mean age of 37 years compared to 30 years in women. Among 94 clients with pulmonary TB, 46% had CD4<200 and would be eligible for ART. [table: see text]

CONCLUSIONS: Of those screened, 35% were eligible for ART. Only 16% of those eligible were based on staging alone. Less men presented for HIV clinical care than women, at an older age with more advanced disease but similar numbers of men and women were eligible for ART. About half of HIV-positive TB patients had CD4<200 and would require ART.

Keywords: AEGIS, CD4 Lymphocyte Count, Patient Selection, HIV Seropositivity, Tuberculosis, Counseling, Antiretroviral Therapy, Highly Active, Tuberculosis, Pulmonary, CD4-Positive T-Lymphocytes, Mass Screening, South Africa, Humans, Male, Female, therapy, drug therapy

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MoOrB1080