Journal Article > ReviewFull Text
Int J Epidemiol. 2016 May 20; Volume 46 (Issue 2); e21.; DOI:doi.org/10.1093/ije/dyw057
Stinson K, Goemaere E, Coetzee D, van Cutsem G, Hilderbrand K, et al.
Int J Epidemiol. 2016 May 20; Volume 46 (Issue 2); e21.; DOI:doi.org/10.1093/ije/dyw057
Journal Article > ResearchFull Text
Southern African Journal of HIV medicine. 2019 June 11; Volume 20 (Issue 1); 905.; DOI:10.4102/sajhivmed.v20i1.905
Sharp J, Wilkinson LS, Cox V, Cragg C, van Custem G, et al.
Southern African Journal of HIV medicine. 2019 June 11; Volume 20 (Issue 1); 905.; DOI:10.4102/sajhivmed.v20i1.905
BACKGROUND
Eligibility for differentiated antiretroviral therapy (ART) delivery models has to date been limited to low-risk stable patients.
OBJECTIVES
We examined the outcomes of patients who accessed their care and treatment through an ART adherence club (AC), a differentiated ART delivery model, immediately following receiving support to achieve viral suppression after experiencing elevated viral loads (VLs) at a high-burden ART clinic in Khayelitsha, South Africa.
METHODS
Beginning in February 2012, patients with VLs above 400 copies/mL either on first or second-line regimens received a structured intervention developed for patients at risk of treatment failure. Patients who successfully suppressed either on the same regimen or after regimen switch were offered immediate enrolment in an AC facilitated by a lay community health worker. We conducted a retrospective cohort analysis of patients who enrolled in an AC directly after receiving suppression support. We analysed outcomes (retention in care, retention in AC care and viral rebound) using Kaplan–Meier methods with follow-up from October 2012 to June 2015.
RESULTS
A total of 165 patients were enrolled in an AC following suppression (81.8% female, median age 36.2 years). At the closure of the study, 119 patients (72.0%) were virally suppressed and 148 patients (89.0%) were retained in care. Six, 12 and 18 months after AC enrolment, retention in care was estimated at 98.0%, 95.0% and 89.0%, respectively. Viral suppression was estimated to be maintained by 90.0%, 84.0% and 75.0% of patients at 6, 12 and 18 months after AC enrolment, respectively.
CONCLUSION
Our findings suggest that patients who struggled to achieve or maintain viral suppression in routine clinic care can have good retention and viral suppression outcomes in ACs, a differentiated ART delivery model, following suppression support.
Eligibility for differentiated antiretroviral therapy (ART) delivery models has to date been limited to low-risk stable patients.
OBJECTIVES
We examined the outcomes of patients who accessed their care and treatment through an ART adherence club (AC), a differentiated ART delivery model, immediately following receiving support to achieve viral suppression after experiencing elevated viral loads (VLs) at a high-burden ART clinic in Khayelitsha, South Africa.
METHODS
Beginning in February 2012, patients with VLs above 400 copies/mL either on first or second-line regimens received a structured intervention developed for patients at risk of treatment failure. Patients who successfully suppressed either on the same regimen or after regimen switch were offered immediate enrolment in an AC facilitated by a lay community health worker. We conducted a retrospective cohort analysis of patients who enrolled in an AC directly after receiving suppression support. We analysed outcomes (retention in care, retention in AC care and viral rebound) using Kaplan–Meier methods with follow-up from October 2012 to June 2015.
RESULTS
A total of 165 patients were enrolled in an AC following suppression (81.8% female, median age 36.2 years). At the closure of the study, 119 patients (72.0%) were virally suppressed and 148 patients (89.0%) were retained in care. Six, 12 and 18 months after AC enrolment, retention in care was estimated at 98.0%, 95.0% and 89.0%, respectively. Viral suppression was estimated to be maintained by 90.0%, 84.0% and 75.0% of patients at 6, 12 and 18 months after AC enrolment, respectively.
CONCLUSION
Our findings suggest that patients who struggled to achieve or maintain viral suppression in routine clinic care can have good retention and viral suppression outcomes in ACs, a differentiated ART delivery model, following suppression support.
Journal Article > ResearchFull Text
AIDS. 2010 February 20; Volume 24 (Issue 4); DOI:10.1097/QAD.0b013e328333bfb7
Boulle AM, van Cutsem G, Hilderbrand K, Cragg C, Abrahams M, et al.
AIDS. 2010 February 20; Volume 24 (Issue 4); DOI:10.1097/QAD.0b013e328333bfb7
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. RESULTS: Seven thousand, three hundred and twenty-three treatment-naive adults (68% women) started ART between 2001 and 2007, with annual enrolment increasing from 80 in 2001 to 2087 in 2006. Of 9.8% of patients lost to follow-up for at least 6 months, 32.8% had died. Corrected mortality was 20.9% at 5 years (95% confidence interval 17.9-24.3). Mortality fell over time as patients accessed care earlier (median CD4 cell count at enrolment increased from 43 cells/microl in 2001 to 131 cells/microl in 2006). Patients who remained virologically suppressed continued to gain CD4 cells at 5 years (median 22 cells/microl per 6 months). By 5 years, 14.0% of patients had failed virologically and 12.2% had been switched to second-line therapy. 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.
Journal Article > CommentaryFull Text
Southern African Journal of HIV medicine. 2014 March 5; DOI:10.7196/SAJHIVMED.1025
Stinson K, Giddy J, Cox V, Burton R, Ibeto M, et al.
Southern African Journal of HIV medicine. 2014 March 5; DOI:10.7196/SAJHIVMED.1025
Journal Article > Short ReportFull Text
AIDS. 2014 September 10; Volume 28 (Issue 14); DOI:10.1097/QAD.0000000000000406
Ford NP, Stinson K, Davies MA, Cox V, Patten GE, et al.
AIDS. 2014 September 10; Volume 28 (Issue 14); DOI:10.1097/QAD.0000000000000406