Scaling up of highly active antiretroviral therapy in a rural district of Malawi: an effectiveness assessment

Ferradini, Laurent; Jeannin, Arnaud; Pinoges, Loretxu; Izopet, Jacques; Odhiambo, Didakus; Mankhambo, Limangeni; Karungi, Gloria; Szumilin, Elisabeth; Balandine, Serge; Fedida, Gaëlle; Carrieri, Patrizia; Spire, Bruno; Ford, Nathan; Tassie, Jean-Michel; Guérin, Philippe J.; Brasher, Christopher

doi:10.1016/s0140-6736(06)68580-2

Cited by 405 publications

(389 citation statements)

References 32 publications

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“…In contrast to other studies [9,10,26, 27], we did not find a significant correlation between low body weight and death. All of the parameters included (low CD4+ T-cell count, Karnofsky score, BMI, and gender) were independently associated with a poor immunological response.…”

Section: Discussioncontrasting

confidence: 99%

“…Immunologic outcomes were good: the mean CD4+ Tcell count increase after one year was 236/mm 3 ; previous studies showed increases in mean CD4+ T-cell counts ranging from 127/mm 3 to 165/mm 3 [5,[8][9][10][11].…”

Section: Discussionmentioning

confidence: 99%

“…This distinction is important, as people living in remote areas often miss out on proper care and the process of scaling-up antiretroviral therapy in such settings in sub-Saharan Africa meets different challenges [10,22]. A recent analysis showed that only 21% of the people in Mpumalanga estimated to be in need of HAART actually received it by the end of 2005 [23].…”

Section: Discussionmentioning

confidence: 99%

“…Unlike many other studies on HAART programs in Africa [8][9][10][11], we measured the viral load in individual patients throughout the treatment period. In contrast to the opinion of some authors [29,30], our data indicate that longitudinal viral load testing is possible in developing countries.…”

Section: Discussionmentioning

confidence: 99%

“…countries [6][7][8][9][10][11]. However, concerns about the lack of infrastructure, irregular medication supply, and poor adherence has led to pessimism about the feasibility of HAART programs in resource-constrained settings.…”

mentioning

confidence: 99%

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Effectiveness of highly active antiretroviral therapy administered by general practitioners in rural South Africa

Barth

Meer

Hoepelman

et al. 2008

Eur J Clin Microbiol Infect Dis

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The purpose of this study was to assess the oneyear efficacy of highly active antiretroviral therapy (HAART) administered by general practitioners in a primary care community clinic in rural South Africa. We performed an observational cohort study of 675 treatmentnaïve human immunodeficiency virus (HIV)-infected patients (including 66 children) who began HAART at least 12 months prior to the data analyses. Throughout treatment, the CD4+ T-cell count (percentage of CD4+ Tcells in children) and plasma HIV-RNA level were determined and the patient's weight was recorded. The primary outcome was mortality. Secondary outcomes were viral suppression, immunological response, and weight gain. One year after the start of HAART, 100 of the 675 (15%) patients were lost to follow-up and 119 patients (18%), including six children, died. Mortality was highest during the first few months of treatment. Based on an ontreatment analysis at one year after the start of therapy, 83% of adults and 71% of children had a viral load <400 copies/ ml; the viral load was <50 copies/ml in 70% of adults and 61% of children. At one year, the mean CD4+ T-cell count in adults had increased by 236/mm 3 , and the mean body mass index (BMI) had increased by 3.5 kg/m 2 . In children, the mean CD4% had increased by 17.6. A low Karnofsky score and a low baseline CD4+ T-cell count were independently associated with death. In addition to these factors, a low baseline BMI and gender were predictive of a poor immunological outcome. Our study shows that adequately monitored HIV/acquired immunodeficiency syndrome (AIDS) care administered by general practitioners and their staff is feasible and leads to good results in a rural, primary care center in sub-Saharan Africa. In order to achieve even better results, early mortality should be reduced and efforts should be made to start HAART earlier.

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Section: Discussioncontrasting

confidence: 99%