title: Outcomes after two years of providing antiretroviral treatment in Khayelitsha, South Africa.
abstract: BACKGROUND
  A community-based antiretroviral therapy (ART) programme was established in 2001 in a South African township to explore the operational issues involved in providing ART in the public sector in resource-limited settings and demonstrate the feasibility of such a service.
  
  
  METHODS
  Data was analysed on a cohort of patients with symptomatic HIV disease and a CD4 lymphocyte count < 200 x 10 cells/l. The programme used standardized protocols (using generic medicines whenever possible), a team-approach to clinical care and a patient-centred approach to promote adherence.
  
  
  RESULTS
  Two-hundred and eighty-seven adults naive to prior ART were followed for a median duration of 13.9 months. The median CD4 lymphocyte count was 43 x 10 cells/l at initiation of treatment, and the mean log10 HIV RNA was 5.18 copies/ml. The HIV RNA level was undetectable (< 400 copies/ml) in 88.1, 89.2, 84.2, 75.0 and 69.7% of patients at 3, 6, 12, 18 and 24 months respectively. The cumulative probability of remaining alive was 86.3% at 24 months on treatment for all patients, 91.4% for those with a baseline CD4 lymphocyte count > or =50 x 10 cells/l, and 81.8% for those with a baseline CD4 lymphocyte count < 50 x 10 cells/l. The cumulative probability of changing a single antiretroviral drug by 24 months was 15.1% due to adverse events or contraindications, and 8.4% due to adverse events alone.
  
  
  CONCLUSIONS
  ART can be provided in resource-limited settings with good patient retention and clinical outcomes. With responsible implementation, ART is a key component of a comprehensive response to the epidemic in those communities most affected by HIV.
authors.affiliation: Infectious Disease Epidemiology Unit, School of Public Health and Family Medicine, University of Cape Town, Anzio Road, Observatory 7925, South Africa.
authors.forename: David
authors.initials: D
authors.lastname: Coetzee
authors.forename: Katherine
authors.initials: K
authors.lastname: Hildebrand
authors.forename: Andrew
authors.initials: A
authors.lastname: Boulle
authors.forename: Gary
authors.initials: G
authors.lastname: Maartens
authors.forename: Francoise
authors.initials: F
authors.lastname: Louis
authors.forename: Veliswa
authors.initials: V
authors.lastname: Labatala
authors.forename: Hermann
authors.initials: H
authors.lastname: Reuter
authors.forename: Nonthutuzelo
authors.initials: N
authors.lastname: Ntwana
authors.forename: Eric
authors.initials: E
authors.lastname: Goemaere
mesh_terms: D000328:Adult; D019380:Anti-HIV Agents / Q000627:therapeutic use*; D003153:Community Health Services / Q000191:economics; D003906:Developing Countries; D016527:Drug Costs; D005260:Female; D005500:Follow-Up Studies; D015658:HIV Infections / Q000188:drug therapy* / Q000401:mortality; D015497:HIV-1; D006801:Humans; D008297:Male; D013019:South Africa / Q000453:epidemiology; D016896:Treatment Outcome; D019562:Viral Load
chemical_list: D019380:Anti-HIV Agents