Evaluation of antiretroviral therapy (ART) provision in an early cohort of patients initiating ART in Ghana

Abstract

IntroductionAgainst the background of Ghana's ART program which scaled up rapidly since inception in 2003, the study assessed outcomes of an early cohort of patients initiating ART.MethodsThe study utilized the following methods: a cross-sectional study involving patient interviews using a structured questionnaire, a review of records and a retrospective cohort analysis of adults initiating ART between 2003 and 2008 from four selected clinics.ResultsThe 683 study participants consisted of 464 females (67.9%) and the mean age was 41 years. Mean duration of treatment was 25 months (SD =13). More than 95% were on a regimen as per national guidelines. Ninety-five (14.1%) of the respondents had one or two drugs substituted. Seventy-three% of the substitutions were due to adverse drug reactions. On at least one occasion, over half (350) had defaulted on a clinic appointment. In the 3 months preceding the survey, 21.4% (146) had missed treatment doses. About 49% (334) had challenges meeting financial obligations related to care. The median weight increased by 5.9kg and 8.0kg at 6 and 12 months after initiating ART respectively over the median baseline weight of 54kg, (p-value = 0.001). The median CD4 count increased by 128, 170 and 256 cells/µl respectively at 6, 12 and 24 months from the median baseline of 125 cell/µl, (p-value = 0.035).ConclusionThis study of Ghanaian PLHIV on ART from four facilities showed encouraging immunological and clinical outcomes. There were however issues of appointment default, sub-optimum adherence to treatment and cost of care barriers needing attention.

Hepatitis B and C infections in HIV-1 patients on combination antiretroviral therapy (cART) in Ghana: implications for immunologic recovery, clinical response to treatment, and hepatotoxicity

“…Similar findings of negative immune recovery have been reported among HIV co-infected patients in other African countries [ 42 , 44 ]. However, the sustained increases in the CD4+ cell count among the HIV mono-infected is reflective of a positive immunological outcome to therapy, which is also consistent with a previous report in Ghana [ 45 ]. Postulated mechanisms underlying HIV-HCV/HBV co-infections include HCV proliferation and the suppression of T helper cells [ 46 , 47 , 48 ], whereas HBV infection is associated with increased T-cell apoptosis [ 49 ].…”

“…Postulated mechanisms underlying HIV-HCV/HBV co-infections include HCV proliferation and the suppression of T helper cells [ 46 , 47 , 48 ], whereas HBV infection is associated with increased T-cell apoptosis [ 49 ]. Moreover, the improvement in weight observed among the HIV mono-infected in our study was similarly demonstrated by Ohene and colleagues who found increases in weight levels after therapy was initiated [ 45 ].…”

Predictors of antiretroviral therapy interruptions and factors influencing return to care at the Nkolndongo Health District, Cameroon

“…This is an evidence of stigmatization as clients feel reluctant to pick up salvage dispensation or transferred to nearby facilities. This was similar to Lifson et al findings that identified travels and stigma in raising attrition 27 – 29 . The mental state of PLHIV and their relationship with care providers affected their consistency in care.…”

Rate of initial highly active anti-retroviral therapy regimen change and its predictors among adult HIV patients at University of Gondar Referral Hospital, Northwest Ethiopia: a retrospective follow up study

“…Furthermore, 13.8/100PY in Thailand [ 8 ], 41.5/100PY in Swiss [ 9 ], 28.3/100PY in Brazil [ 10 ], 16.2/100PY in West Africa [ 11 ], 18.6/100PY in Kenya [ 12 ] and the proportion of regimen change in Ethiopia was 21.8 % [ 13 ]. Different studies revealed that baseline regimen [ 1 , 12 , 14 ], WHO stage [ 12 , 15 ], CD4 count [ 6 , 16 , 17 ] and patient weight [ 12 , 15 ] were some predictors of initial regimen change.…”