Recent Publications

Response to: defaulting from antiretroviral treatment programmes in sub-Saharan Africa: a problem of definition

Abstract: The recent letter to the editors by Grimsrud et al. (2011) in response to our review of rates of retention in antiretroviral treatment programmes in sub-Saharan Africa (Fox & Rosen 2010) raises two concerns that we would like to comment on. First, the authors make the point that there was variability in the definitions of loss to follow-up (LTFU) used by the studies we summarized. This is correct: as is clearly noted in the paper, we did not have access to the primary data used 

Correcting Mortality for Loss to Follow-Up: A Nomogram Applied to Antiretroviral Treatment Programmes in Sub-Saharan Africa

Abstract Background: The World Health Organization estimates that in sub-Saharan Africa about 4 million HIV-infected patients had started antiretroviral therapy (ART) by the end of 2008. Loss of patients to follow-up and care is an important problem for treatment programmes in this region. As mortality is high in these patients compared to patients remaining in care, ART programmes with high rates of loss to follow-up may substantially underestimate mortality of all patients starting ART. 

The importance of clinic attendance in the first six months on antiretroviral treatment: a retrospective analysis at a large public sector HIV clinic in South Africa

Abstract Background: Adherence to care and treatment are essential for HIV-infected individuals to benefit from antiretroviral therapy (ART). We sought to quantify the effects on treatment outcomes of missing visits soon after initiating ART. Methods: We analyzed data from HIV-infected patients initiating ART at Themba Lethu Clinic, Johannesburg, South Africa, from April 2004 to August 2008. We used log-binomial regression to evaluate the relative risk of missing visits during the first six 

Economic outcomes of patients receiving antiretroviral therapy for HIV/AIDS in South Africa are sustained through three years on treatment

Abstract Background: Although the medical outcomes of antiretroviral therapy (ART) for HIV/AIDS are well described, less is known about how ART affects patients' economic activities and quality of life, especially after the first year on ART. We assessed symptom prevalence, general health, ability to perform normal activities, and employment status among adult antiretroviral therapy patients in South Africa over three full years following ART initiation. Methodology/Principal Findings: A 

Temporal changes in programme outcomes among adult patients initiating antiretroviral therapy across South Africa

Abstract South Africa has the largest ART programme in the world . Between 2004 (the start of the national ART programme) and 2007, an estimated 370,000 people initiated treatment in the public sector . But despite the scope and rapid growth of this programme there are no data on programme outcomes at a national level. The International Epidemiologic Databases to Evaluate AIDS collaboration of Southern Africa (IeDEA-SA) has assembled a series of HIV treatment cohorts from across the country 

Lost opportunities to complete CD4+ lymphocyte testing among patients who tested positive for HIV in South Africa

Abstract Objective: To estimate rates of completion of CD4+ lymphocyte testing (CD4 testing) within 12 weeks of testing positive for human immunodeficiency virus (HIV) at a large HIV/AIDS clinic in South Africa, and to identify clinical and demographic predictors for completion. Methods: In our study, CD4 testing was considered complete once a patient had retrieved the test results. To determine the rate of CD4 testing completion, we reviewed the records of all clinic patients who tested 

Initiating patients on antiretroviral therapy at CD4 cell counts above 200 cells/µl is associated with improved treatment outcomes in South Africa

Abstract Objectives: To compare treatment outcomes by starting CD4 counts using data from the CIPRA-South Africa trial. Design: Observational cohort study. Methods: Patients presenting to primary care clinics with CD4 cell counts <350 cells/mm3 were randomized to either doctor- or nurse-managed HIV care and followed for at least two years after ART initiation. Clinical and laboratory outcomes were compared by baseline CD4 count. Results: 812 patients were followed for a median of 27.5 

Nurse versus doctor management of HIV-infected patients receiving antiretroviral therapy (CIPRA-SA): a randomised non-inferiority trial

Abstract Background: Expanded access to combination antiretroviral therapy (ART) in the resource-poor setting is dependent on “task-shifting” from doctors to other health care providers. We compared “doctor-initiated-nurse-monitored” care to the current standard of care, “doctor-initiated-doctor-monitored” ART. Methods: A randomised strategy trial to determine whether treatment outcomes of “nurse-monitored” ART were non-inferior to “doctor-monitored” ART was conducted at 

Cost of using a patient tracer to reduce loss to follow up and ascertain patient status in a large antiretroviral therapy program in Johannesburg, South Africa

Abstract Objective: To evaluate a pilot intervention to engage a patient tracer to follow up lost patients at a large public clinic in South Africa. Methods: A social worker spent 4 months contacting by telephone a random sample of patients who had initiated antiretroviral therapy (ART) at least 6 months earlier and were ≥1 month late for a scheduled visit. The tracer was authorized to assist patients to return to care if needed. Cost was calculated from the perspective of the clinic. 

Why are antiretroviral treatment patients lost to follow up? A qualitative study from South Africa

Abstract Objectives: To better understand the reasons why patients default from antiretroviral treatment (ART) programmes to help design interventions that improve treatment retention and ultimately, patient outcomes. Methods: Prospective cohort study at two treatment sites in South Africa followed by qualitative interviews with patients that had defaulted. Results: Respondents overwhelmingly reported that ART improved their health status and quality of life. Nevertheless, despite improved 

Early loss to follow up after enrollment in pre-ART care at a large public clinic in Johannesburg, South Africa

Abstract Objective: To estimate loss to follow up (LTFU) between initial enrolment and the first scheduled return medical visit of a pre-antiretroviral therapy (ART) care program for patients not eligible for ART. Methods: The study was conducted at a public-sector HIV clinic in Johannesburg. We reviewed records of all patients newly enrolled in the pre-ART care program and not yet eligible for ART between January 2007 and February 2008. Crude proportions of patients completing their first 

Strategies to improve patient retention on antiretroviral therapy in sub-Saharan Africa

Abstract The scale-up of antiretroviral therapy (ART) has been one of the success stories of sub-Saharan Africa, where coverage has increased from about 2% in 2003 to more than 40% 5 years later. However, tempering this success is a growing concern about patient retention (the proportion of patients who are alive and remaining on ART in the health system). Based on the personal experience of the authors, 10 key interventions are presented and discussed that might help to improve patient