Monitoring the South African National Antiretroviral Treatment Programme, 2003 - 2007: The IeDEA Southern Africa collaboration
AbstractObjectives. To introduce the combined South African cohorts
of the International epidemiologic Databases to Evaluate
AIDS Southern Africa (IeDEA-SA) collaboration as reflecting
the South African national antiretroviral treatment (ART)
programme; to characterise patients accessing these services;
and to describe changes in services and patients from 2003 to
Design and setting. Multi-cohort study of 11 ART programmes
in Gauteng, Western Cape, Free State and KwaZulu-Natal.
Subjects. Adults and children (<16 years old) who initiated
ART with .3 antiretroviral drugs before 2008.
Results. Most sites were offering free treatment to adults
and children in the public sector, ranging from 264 to 17 835
patients per site. Among 45 383 adults and 6 198 children
combined, median age (interquartile range) was 35.0 years
(29.8 - 41.4) and 42.5 months (14.7 - 82.5), respectively. Of
adults, 68% were female. The median CD4 cell count was
102 cells/ƒÊl (44 - 164) and was lower among males than
females (86, 34 - 150 v. 110, 50 - 169, p<0.001). Median CD4%
among children was 12% (7 - 17.7). Between 2003 and 2007,
enrolment increased 11-fold in adults and 3-fold in children.
Median CD4 count at enrolment increased for all adults
(67 - 111 cells/ƒÊl, p<0.001) and for those in stage IV (39 - 89
cells/ƒÊl, p<0.001). Among children <5 years, baseline CD4%
increased over time (11.5 - 16.0%, p<0.001).
Conclusions. IeDEA-SA provides a unique opportunity to
report on the national ART programme. The study describes
dramatically increased enrolment over time. Late diagnosis
and ART initiation, especially of men and children, need
attention. Investment in sentinel sites will ensure good
individual-level data while freeing most sites to continue with
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