Making Universal Access a Reality—What More Do We Need to Know?

Hirschhorn, Lisa R.; Skolnik, Richard

doi:10.1086/587185

Cited by 2 publications

(1 citation statement)

References 12 publications

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“…A study from the Free State Province in South Africa suggested that 87% of all deaths were in patients who had not started ART (2). Starting eligible patients on treatment as quickly as possible is therefore a priority (3), but resource limitations mean that patients often have to wait for treatment (5;6). …”

Section: Introductionmentioning

confidence: 99%

Outcomes in patients waiting for antiretroviral treatment in the Free State Province, South Africa: prospective linkage study

Ingle

May

Uebel

et al. 2010

Aids

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Objective In South Africa, many HIV-infected patients experience delays in accessing antiretroviral therapy (ART). We examined pre-treatment mortality and access to treatment in patients waiting for ART. Design Cohort of HIV-infected patients assessed for ART eligibility at 36 facilities participating in the Comprehensive HIV and AIDS Management (CHAM) program in the Free State Province. Methods Proportion of patients initiating ART, pre-ART mortality and risk factors associated with these outcomes were estimated using competing risks survival analysis. Results 44,844 patients enrolled in CHAM between May 2004 and December 2007, of whom 22,083 (49.2%) were eligible for ART; pre-ART mortality was 53.2 per 100 person-years (95% CI 51.8-54.7). Median CD4 count at eligibility increased from 87 cells/mm3 in 2004 to 101 cells/mm3 in 2007. Two years after eligibility an estimated 67.7% (67.1% – 68.4%) of patients had started ART, and 26.2% (25.6% - 26.9%) died before starting ART. Among patients with CD4 counts <25 cells/mm3 at eligibility, 48% died before ART and 51% initiated ART. Men were less likely to start treatment and more likely to die than women. Patients in rural clinics or clinics with low staffing levels had lower rates of starting treatment and higher mortality compared with patients in urban/ peri-urban clinics, or better staffed clinics. Conclusions Mortality is high in eligible patients waiting for ART in the Free State Province. The most immunocompromised patients had the lowest probability of starting ART and the highest risk of pre-ART death. Prioritization of these patients should reduce waiting times and pre-ART mortality.

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Section: Introductionmentioning

confidence: 99%

Outcomes in patients waiting for antiretroviral treatment in the Free State Province, South Africa: prospective linkage study

Ingle

May

Uebel

et al. 2010

Aids

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Differences in access and patient outcomes across antiretroviral treatment clinics in the Free State province: A prospective cohort study

Ingle¹,

May²,

Uebel

et al. 2010

S Afr Med J

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Objective. To assess differences in access to antiretroviral treatment (ART) and patient outcomes across public sector treatment facilities in the Free State province, South Africa.Design. Prospective cohort study with retrospective database linkage. We analysed data on patients enrolled in the treatment programme across 36 facilities between May 2004 and December 2007, and assessed percentage initiating ART and percentage dead at 1 year after enrolment. Multivariable logistic regression was used to estimate associations of facility-level and patient-level characteristics with both mortality and treatment status.Results. Of 44 866 patients enrolled, 15 219 initiated treatment within 1 year; 8 778 died within 1 year, 7 286 before accessing ART. Outcomes at 1 year varied greatly across facilities and more variability was explained by facility-level factors than by patient-level factors. The odds of starting treatment within 1 year improved over calendar time. Patients enrolled in facilities with treatment initiation available on site had higher odds of starting treatment and lower odds of death at 1 year compared with those enrolled in facilities that did not offer treatment initiation. Patients were less likely to start treatment if they were male, severely immunosuppressed (CD4 count ≤50 cells/µl), or underweight (<50 kg). Men were also more likely to die in the first year after enrolment.Conclusions. Although increasing numbers of patients started ART between 2004 and 2007, many patients died before accessing ART. Patient outcomes could be improved by decentralisation of treatment services, fast-tracking the most immunodeficient patients and improving access, especially for men.S Afr Med J 2010; 100: 675-681b.

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Making Universal Access a Reality—What More Do We Need to Know?

Cited by 2 publications

References 12 publications

Outcomes in patients waiting for antiretroviral treatment in the Free State Province, South Africa: prospective linkage study

Outcomes in patients waiting for antiretroviral treatment in the Free State Province, South Africa: prospective linkage study

Differences in access and patient outcomes across antiretroviral treatment clinics in the Free State province: A prospective cohort study

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