Clinical outcomes and patient retention in the antiretroviral roll-out programme at Letaba Hospital, Limpopo Province, South Africa.

[摘要] The roll-out of antiretroviral drugs in South Africa started in March 2004. In Mopanidistrict, a rural district of Limpopo Province, the roll-out programme commenced inOctober 2004. While many resources were invested in this program, no study has assessedthe clinical outcomes in this rural district. In addition, most studies conducted in SouthAfrica were conducted in urban and tertiary settings. Assessing clinical outcomes isimportant in determining whether the program is making the desired clinical difference inthe lives of the patients and may serve as feedback into the program for qualityimprovement purposes.MethodologyThe study was a retrospective record review of patients who were initiated onantiretroviral (ARV) treatment between December 2007 and November 2008. Astructured questionnaire was used to collect data from 124 patient’s files and data wascollected up to November 2011. The data collected included patients’ socio-demographiccharacteristics, clinical outcomes (CD4 count, viral load, presence of opportunisticinfections, adverse effects and hospital admissions recorded at 6, 12, 24 and 36 months),the number of patients who were still attending the ARV clinic at 36 months and thereasons why patients are no longer attending the clinic. Data was analysed with Epi-Infoand STATA.ResultsOf the 124 patients, 69% were females, 28% males and 3% did not have their sexspecified. The majority of the patients were between 30 and 49 years. There was asignificant improvement in CD4 count and viral load between baseline and all timeperiodsafter the initiation of ARV treatment. The mean CD4 count at baseline was 128The roll-out of antiretroviral drugs in South Africa started in March 2004. In Mopanidistrict, a rural district of Limpopo Province, the roll-out programme commenced inOctober 2004. While many resources were invested in this program, no study has assessedthe clinical outcomes in this rural district. In addition, most studies conducted in SouthAfrica were conducted in urban and tertiary settings. Assessing clinical outcomes isimportant in determining whether the program is making the desired clinical difference inthe lives of the patients and may serve as feedback into the program for qualityimprovement purposes.MethodologyThe study was a retrospective record review of patients who were initiated onantiretroviral (ARV) treatment between December 2007 and November 2008. Astructured questionnaire was used to collect data from 124 patient’s files and data wascollected up to November 2011. The data collected included patients’ socio-demographiccharacteristics, clinical outcomes (CD4 count, viral load, presence of opportunisticinfections, adverse effects and hospital admissions recorded at 6, 12, 24 and 36 months),the number of patients who were still attending the ARV clinic at 36 months and thereasons why patients are no longer attending the clinic. Data was analysed with Epi-Infoand STATA.ResultsOf the 124 patients, 69% were females, 28% males and 3% did not have their sexspecified. The majority of the patients were between 30 and 49 years. There was asignificant improvement in CD4 count and viral load between baseline and all timeperiodsafter the initiation of ARV treatment. The mean CD4 count at baseline was 128The roll-out of antiretroviral drugs in South Africa started in March 2004. In Mopanidistrict, a rural district of Limpopo Province, the roll-out programme commenced inOctober 2004. While many resources were invested in this program, no study has assessedthe clinical outcomes in this rural district. In addition, most studies conducted in SouthAfrica were conducted in urban and tertiary settings. Assessing clinical outcomes isimportant in determining whether the program is making the desired clinical difference inthe lives of the patients and may serve as feedback into the program for qualityimprovement purposes.MethodologyThe study was a retrospective record review of patients who were initiated onantiretroviral (ARV) treatment between December 2007 and November 2008. Astructured questionnaire was used to collect data from 124 patient’s files and data wascollected up to November 2011. The data collected included patients’ socio-demographiccharacteristics, clinical outcomes (CD4 count, viral load, presence of opportunisticinfections, adverse effects and hospital admissions recorded at 6, 12, 24 and 36 months),the number of patients who were still attending the ARV clinic at 36 months and thereasons why patients are no longer attending the clinic. Data was analysed with Epi-Infoand STATA.ResultsOf the 124 patients, 69% were females, 28% males and 3% did not have their sexspecified. The majority of the patients were between 30 and 49 years. There was asignificant improvement in CD4 count and viral load between baseline and all timeperiodsafter the initiation of ARV treatment. The mean CD4 count at baseline was 128 cells/mm3; it increased to 310 cells/mm3 at 6 months, 380 cells/mm3 at 12 months and 470cells/mm3 at 24 months. By 6 months, 67% of the patients had achieved viral suppression,but at 24 months, patients started having viral rebound. During the study, 20 patients fellpregnant and four patients fell pregnant twice. Overall, pregnant patients had asignificantly higher viral load compared to non-pregnant patients (p-values = 0.015 at 6months, 0.002 at 12 months and 0.027 at 24 months). Seventy two percent of patients wereretained in the program at 36 months. Of the 28% that were no longer attending the clinic,11.3% were transferred to other institutions, 6.5% were down referred to clinics, 3.2%died, 3.2% defaulted and 3.2% were lost to follow-up.ConclusionThis study shows that good clinical outcomes can be achieved within an antiretroviral rolloutprogram in a rural hospital. The biggest magnitude of clinical benefits was observed inthe first six months after the initiation of ARV treatment with threats of viral reboundthereafter. There was good patient retention at 36 months after initiation of ARV treatmentand a significant difference in viral load between pregnant and non-pregnant patients. Thehigh rate of unplanned pregnancy signifies the need to place closer attention to family planning among female patients on antiretroviral treatment.

[发布机构] University of the Witwatersrand