Evaluation of a workplace HIV treatment programme in South Africa.
OBJECTIVE
To review the experience of implementing a workplace HIV care programme in South Africa and describe treatment outcomes in sequential cohorts of individuals starting antiretroviral therapy (ART).


METHODS
A review of an industrial HIV care and treatment programme. Between October 2002 and December 2005, 2262 patients enrolled in the HIV care programme.


RESULTS
CD4 cell counts increased by a median of 90, 113 and 164 cells/microl by 6, 12 and 24 months on treatment, respectively. The viral load was suppressed below 400 copies/ml in 75, 72 and 72% of patients at 6, 12 and 24 months, respectively, at an average cost of US$1654, 3567 and 7883 per patient virally suppressed, respectively. Treatment outcomes in sequential cohorts of patients were consistent over time. A total of 93.6% of patients at 14,752 clinic visits reported missing no tablets over the previous 3 days. Almost half the patients (46.8%) experienced one or more adverse events, although most were mild (78.7%). By the end of December 2005, 30% of patients were no longer on ART, mostly because of defaulted or stopped treatment (12.8%), termination of employment (8.2%), or death (4.9%).


CONCLUSIONS
This large workplace programme achieved virological results among individuals retained in the programme comparable to those reported for developed countries; more work is needed to improve retention. Monitoring treatment outcomes in sequential cohorts is a useful way of monitoring programme performance. As the programme has matured, the costs of programme implementation have reduced. Counselling is a central component of an ART programme. Challenges in implementing a workplace ART programme are similar to the challenges of public-sector programmes.
Aurum Institute for Health Research, Johannesburg, South Africa. salomec@auruminstitute.org
Salome
S
Charalambous
Craig
C
Innes
Debbie
D
Muirhead
Lilani
L
Kumaranayake
Katherine
K
Fielding
Lindiwe
L
Pemba
Robin
R
Hamilton
Alison
A
Grant
Gavin J
GJ
Churchyard
D000328:Adult; D019380:Anti-HIV Agents / Q000191:economics / Q000627:therapeutic use; D015331:Cohort Studies; D005260:Female; D015658:HIV Infections / Q000188:drug therapy* / Q000191:economics*; D006801:Humans; D008297:Male; D008875:Middle Aged; D009786:Occupational Health Services / Q000191:economics; D013019:South Africa; D016896:Treatment Outcome; D017132:Workplace
D019380:Anti-HIV Agents