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

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Date

2007

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International Epidemiologic Databases to Evaluate AIDS Southern Africa (IeDEA-SA), University of Cape Town, Cape Town, ZA

Abstract

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. We assessed percentage initiating ART and percentage dead, at one year after enrolment. Multivariable logistic regression was used to estimate associations of clinic-level and patient-level characteristics with both mortality and treatment status. Results: Of 44,866 patients enrolled, 15,219 initiated treatment within one year. 8,778 died within one year, of whom 7,286 died before accessing ART. Outcomes at one year varied greatly across facilities and more variability was explained by clinic-level factors than by patient-level factors. The odds of starting treatment within one 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 one year compared to those enrolled in facilities that do not offer treatment initiation. Patients were less likely to start treatment if they were male, severely immunosuppressed (CD4 count <50 cells/ mm3), or underweight (< 50kg). 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.

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Keywords

AIDS, INFORMATION TECHNOLOGY, DATABASES, ANTIRETROVIRAL THERAPY, SOUTH AFRICA, PHARMACEUTICALS, INFORMATION MANAGEMENT, HEALTH-CARE DELIVERY

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http://hdl.handle.net/10625/41636

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IDRC Research Results / Résultats de recherches du CRDI
2000-2009 / Années 2000-2009
Research Results (ACACIA) / Résultats de recherches (ACACIA)