Scaling up antiretroviral treatment in resource-poor settings

Harries, Anthony; Schouten, Erik J; Libamba, Edwin

doi:10.1016/s0140-6736(06)68809-0

Cited by 110 publications

(78 citation statements)

References 7 publications

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“…Low baseline CD4 cell count, an AIDS diagnosis and a low body weight were all strongly associated with 30 (27)(28)(29)(30)(31)(32)(33)(34) 31 (27)(28)(29)(30)(31)(32)(33)(34)(35)(36)(37) 31 (27)(28)(29)(30)(31)(32)(33)(34)(35)(36) 31 (27)(28)(29)(30)(31)(32)(33)(34)(35)(36)(37)(38) 31 (27)(28)(29)(30)(31)(32)(33)(34)(35)(36)…”

Section: Resultsmentioning

confidence: 99%

Seven-year experience of a primary care antiretroviral treatment programme in Khayelitsha, South Africa

Boulle

Cutsem

Hilderbrand

et al. 2010

Aids

247

267

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Objectives: We report on outcomes after 7 years of a community-based antiretroviral therapy (ART) programme in Khayelitsha, South Africa, with death registry linkages to correct for mortality under-ascertainment.Design: This is an observational cohort study.Methods: Since inception, patient-level clinical data have been prospectively captured on-site into an electronic patient information system. Patients with available civil identification numbers who were lost to follow-up were matched with the national death registry to ascertain their vital status. Corrected mortality estimates weighted these patients to represent all patients lost to follow-up. CD4 cell count outcomes were reported conditioned on continuous virological suppression. Conclusion: At a time of considerable debate about future global funding of ART programmes in resource-poor settings, this study has demonstrated substantial and durable clinical benefits for those able to access ART throughout this period, in spite of increasing loss to follow-up. ß

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Section: Resultsmentioning

confidence: 99%

Seven-year experience of a primary care antiretroviral treatment programme in Khayelitsha, South Africa

Boulle

Cutsem

Hilderbrand

et al. 2010

Aids

247

267

View full text Add to dashboard Cite

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“…This is illustrated in Malawi, where the national ART scale-up plan launched in 2004 involved non-physician clinicians providing ART. 7,14 By September 2007, 130 488 patients had been started on ART at 154 health facilities (Ministry of Health ART Quarterly Report: Results up to 30 September, 2007). Task shifting, coupled with a simplified and standardized public health approach and strong supervision, made it possible to scale up ART with acceptable quality standards resulting in many lives saved.…”

Section: Improves Access To Life-saving Treatment and Improves Survivalmentioning

confidence: 99%

“…Task shifting, coupled with a simplified and standardized public health approach and strong supervision, made it possible to scale up ART with acceptable quality standards resulting in many lives saved. 7 In Malawi, Lesotho and in Lusikisiki, South Africa, nurses initiated and managed ART at rural primary health clinics with support from mobile medical teams who provided clinical mentoring. This enabled access for patients who otherwise might not have received the treatment they needed.…”

Section: Improves Access To Life-saving Treatment and Improves Survivalmentioning

confidence: 99%

“…4,5 The scale-up of antiretroviral treatment (ART) in subSaharan Africa has highlighted the human resource challenge of delivering and sustaining this life-saving intervention. [6][7][8] Consequently, the delegation of medical and health service duties from higher to lower cadres or new cadres, known as task shifting, is increasingly promoted as a coping mechanism for general and specific human resource shortages. Table 1 classifies different types of task shifting commonly seen in Africa.…”

Section: Introductionmentioning

confidence: 99%

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Task shifting in HIV/AIDS: opportunities, challenges and proposed actions for sub-Saharan Africa

Zachariah

Ford

Philips

et al. 2009

Transactions of the Royal Society of Tropical Medicine and Hygi

330

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“…It has since shown that, using a simple standardised approach to ART delivery, treatment can be effectively delivered to large numbers of patients. 1,2 How-ever, the main focus has been on HIV-positive individuals eligible for ART either on the basis of clinical criteria (WHO clinical stage 3 or 4) or advanced immunodeficiency (CD4 cell count <250 cells/mm 3 ), and limited attention has been paid to individuals with less advanced disease who are not yet eligible for ART. This is because the national priority has understandably focused on individuals who are at relatively higher risk of HIV-related morbidity and mortality.…”

Section: Introductionmentioning

confidence: 99%

Unacceptable attrition among WHO stages 1 and 2 patients in a hospital-based setting in rural Malawi: can we retain such patients within the general health system?

Tayler‐Smith

Zachariah

Massaquoi

et al. 2010

Transactions of the Royal Society of Tropical Medicine and Hygi

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CitationUnacceptable attrition among WHO stages 1 and 2 patients in a hospital-based setting in rural Malawi: can we retain such patients within the general health system? 2010, 104 a b s t r a c tA study conducted among HIV-positive adults in WHO clinical stages 1 and 2 was followed up at Thyolo District Hospital (rural Malawi) to report on: (1) retention and attrition before and while on antiretroviral treatment (ART); and (2) the criteria used for initiating ART. Between June 2008 and January 2009, 1633 adults in WHO stages 1 and 2 were followed up for a total of 282 person-years. Retention in care at 1, 2, 3 and 6 months for those not on ART (n = 1078) was 25, 18, 11 and 4% vs. 99, 97, 95 and 90% for patients who started ART (n = 555, P = 0.001). Attrition rates were 31 times higher among patients not started on ART compared with those started on ART (adjusted hazard ratio, 31.0, 95% CI 22-44). Ninety-two patients in WHO stage 1 or 2 were started on ART without the guidance of a CD4 count, and 11 were incorrectly started on ART with CD4 count ≥250 cells/mm 3 . In a rural district hospital setting in Malawi, attrition of individuals in WHO stages 1 and 2 is unacceptably high, and specific operational strategies need to be considered to retain such patients in the health system.

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Scaling up antiretroviral treatment in resource-poor settings

Cited by 110 publications

References 7 publications

Seven-year experience of a primary care antiretroviral treatment programme in Khayelitsha, South Africa

Seven-year experience of a primary care antiretroviral treatment programme in Khayelitsha, South Africa

Task shifting in HIV/AIDS: opportunities, challenges and proposed actions for sub-Saharan Africa

Unacceptable attrition among WHO stages 1 and 2 patients in a hospital-based setting in rural Malawi: can we retain such patients within the general health system?

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