The roll-out of antiretroviral drugs in South Africa started in March 2004. In Mopani
district, a rural district of Limpopo Province, the roll-out programme commenced in
October 2004. While many resources were invested in this program, no study has assessed
the clinical outcomes in this rural district. In addition, most studies conducted in South
Africa were conducted in urban and tertiary settings. Assessing clinical outcomes is
important in determining whether the program is making the desired clinical difference in
the lives of the patients and may serve as feedback into the program for quality
improvement purposes.
Methodology
The study was a retrospective record review of patients who were initiated on
antiretroviral (ARV) treatment between December 2007 and November 2008. A
structured questionnaire was used to collect data from 124 patient’s files and data was
collected up to November 2011. The data collected included patients’ socio-demographic
characteristics, clinical outcomes (CD4 count, viral load, presence of opportunistic
infections, adverse effects and hospital admissions recorded at 6, 12, 24 and 36 months),
the number of patients who were still attending the ARV clinic at 36 months and the
reasons why patients are no longer attending the clinic. Data was analysed with Epi-Info
and STATA.
Results
Of the 124 patients, 69% were females, 28% males and 3% did not have their sex
specified. The majority of the patients were between 30 and 49 years. There was a
significant improvement in CD4 count and viral load between baseline and all timeperiods
after the initiation of ARV treatment. The mean CD4 count at baseline was 128The roll-out of antiretroviral drugs in South Africa started in March 2004. In Mopani
district, a rural district of Limpopo Province, the roll-out programme commenced in
October 2004. While many resources were invested in this program, no study has assessed
the clinical outcomes in this rural district. In addition, most studies conducted in South
Africa were conducted in urban and tertiary settings. Assessing clinical outcomes is
important in determining whether the program is making the desired clinical difference in
the lives of the patients and may serve as feedback into the program for quality
improvement purposes.
Methodology
The study was a retrospective record review of patients who were initiated on
antiretroviral (ARV) treatment between December 2007 and November 2008. A
structured questionnaire was used to collect data from 124 patient’s files and data was
collected up to November 2011. The data collected included patients’ socio-demographic
characteristics, clinical outcomes (CD4 count, viral load, presence of opportunistic
infections, adverse effects and hospital admissions recorded at 6, 12, 24 and 36 months),
the number of patients who were still attending the ARV clinic at 36 months and the
reasons why patients are no longer attending the clinic. Data was analysed with Epi-Info
and STATA.
Results
Of the 124 patients, 69% were females, 28% males and 3% did not have their sex
specified. The majority of the patients were between 30 and 49 years. There was a
significant improvement in CD4 count and viral load between baseline and all timeperiods
after the initiation of ARV treatment. The mean CD4 count at baseline was 128 The roll-out of antiretroviral drugs in South Africa started in March 2004. In Mopani
district, a rural district of Limpopo Province, the roll-out programme commenced in
October 2004. While many resources were invested in this program, no study has assessed
the clinical outcomes in this rural district. In addition, most studies conducted in South
Africa were conducted in urban and tertiary settings. Assessing clinical outcomes is
important in determining whether the program is making the desired clinical difference in
the lives of the patients and may serve as feedback into the program for quality
improvement purposes.
Methodology
The study was a retrospective record review of patients who were initiated on
antiretroviral (ARV) treatment between December 2007 and November 2008. A
structured questionnaire was used to collect data from 124 patient’s files and data was
collected up to November 2011. The data collected included patients’ socio-demographic
characteristics, clinical outcomes (CD4 count, viral load, presence of opportunistic
infections, adverse effects and hospital admissions recorded at 6, 12, 24 and 36 months),
the number of patients who were still attending the ARV clinic at 36 months and the
reasons why patients are no longer attending the clinic. Data was analysed with Epi-Info
and STATA.
Results
Of the 124 patients, 69% were females, 28% males and 3% did not have their sex
specified. The majority of the patients were between 30 and 49 years. There was a
significant improvement in CD4 count and viral load between baseline and all timeperiods
after the initiation of ARV treatment. The mean CD4 count at baseline was 128 cells/mm3; it increased to 310 cells/mm3 at 6 months, 380 cells/mm3 at 12 months and 470
cells/mm3 at 24 months. By 6 months, 67% of the patients had achieved viral suppression,
but at 24 months, patients started having viral rebound. During the study, 20 patients fell
pregnant and four patients fell pregnant twice. Overall, pregnant patients had a
significantly higher viral load compared to non-pregnant patients (p-values = 0.015 at 6
months, 0.002 at 12 months and 0.027 at 24 months). Seventy two percent of patients were
retained in the program at 36 months. Of the 28% that were no longer attending the clinic,
11.3% were transferred to other institutions, 6.5% were down referred to clinics, 3.2%
died, 3.2% defaulted and 3.2% were lost to follow-up.
Conclusion
This study shows that good clinical outcomes can be achieved within an antiretroviral rollout
program in a rural hospital. The biggest magnitude of clinical benefits was observed in
the first six months after the initiation of ARV treatment with threats of viral rebound
thereafter. There was good patient retention at 36 months after initiation of ARV treatment
and a significant difference in viral load between pregnant and non-pregnant patients. The
high rate of unplanned pregnancy signifies the need to place closer attention to family planning among female patients on antiretroviral treatment.
| Identifer | oai:union.ndltd.org:netd.ac.za/oai:union.ndltd.org:wits/oai:wiredspace.wits.ac.za:10539/14576 |
| Date | 24 April 2014 |
| Creators | Semenya, Matshehla Mary-Anne Lebogang |
| Source Sets | South African National ETD Portal |
| Language | English |
| Detected Language | English |
| Type | Thesis |
| Format | application/pdf |
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