title: Antiretroviral therapy and early mortality in South Africa.
abstract: OBJECTIVE
  To describe province-wide outcomes and temporal trends of the Western Cape Province antiretroviral treatment (ART) programme 5 years since inception, and to demonstrate the utility of the WHO monitoring system for ART.
  
  
  METHODS
  The treatment programme started in 2001 through innovator sites. Rapid scaling-up of ART provision began early in 2004, located predominantly in primary-care facilities. Data on patients starting ART were prospectively captured into facility-based registers, from which monthly cross-sectional activity and quarterly cohort reports were aggregated. Retention in care, mortality, loss to follow-up and laboratory outcomes were calculated at 6-monthly durations on ART.
  
  
  RESULTS
  By the end of March 2006, 16 234 patients were in care. The cohort analysis included 12 587 adults and 1709 children. Women accounted for 70% of adults enrolled. After 4 and 3 years on ART respectively, 72.0% of adults (95% confidence interval, CI: 68.0-75.6) and 81.5% (95% CI: 75.7-86.1) of children remained in care. The percentage of adults starting ART with CD4 counts less than 50 cells/microl fell from 51.3% in 2001 to 21.5% in 2005, while mortality at 6 months fell from 12.7% to 6.6%, offset in part by an increase in loss to follow-up (reaching 4.7% at 6 months in 2005). Over 85% of adults tested had viral loads below 400 copies/ml at 6-monthly durations until 4 years on ART.
  
  
  CONCLUSIONS
  The location of care in primary-care sites in this programme was associated with good retention in care, while the scaling-up of ART provision was associated with reduced early mortality.
authors.affiliation: School of Public Health and Family Medicine, University of Cape Town, Cape Town, South Africa. andrew.boulle@uct.ac.za
authors.forename: Andrew
authors.initials: A
authors.lastname: Boulle
authors.forename: Peter
authors.initials: P
authors.lastname: Bock
authors.forename: Meg
authors.initials: M
authors.lastname: Osler
authors.forename: Karen
authors.initials: K
authors.lastname: Cohen
authors.forename: Liezl
authors.initials: L
authors.lastname: Channing
authors.forename: Katherine
authors.initials: K
authors.lastname: Hilderbrand
authors.forename: Eula
authors.initials: E
authors.lastname: Mothibi
authors.forename: Virginia
authors.initials: V
authors.lastname: Zweigenthal
authors.forename: Neviline
authors.initials: N
authors.lastname: Slingers
authors.forename: Keith
authors.initials: K
authors.lastname: Cloete
authors.forename: Fareed
authors.initials: F
authors.lastname: Abdullah
mesh_terms: D000328:Adult; D019380:Anti-HIV Agents / Q000627:therapeutic use*; D002648:Child; D015331:Cohort Studies; D015658:HIV Infections / Q000188:drug therapy* / Q000401:mortality*; D006801:Humans; D013019:South Africa / Q000453:epidemiology
chemical_list: D019380:Anti-HIV Agents
references.citation: Cytometry. 2002 Apr 15;50(2):69-77
references.pmid: 12116348
references.citation: Bull World Health Organ. 2005 Jul;83(7):489-94
references.pmid: 16175822
references.citation: PLoS Med. 2007 Oct 16;4(10):e298
references.pmid: 17941716
references.citation: Trans R Soc Trop Med Hyg. 2004 Dec;98(12):695-701
references.pmid: 15485699
references.citation: AIDS. 2004 Apr 9;18(6):887-95
references.pmid: 15060436
references.citation: AIDS. 2005 Dec 2;19(18):2141-8
references.pmid: 16284464
references.citation: AIDS. 2004 Jun;18 Suppl 3:S27-31
references.pmid: 15322481
references.citation: J Am Med Inform Assoc. 2006 May-Jun;13(3):253-60
references.pmid: 16501175
references.citation: Lancet. 2006 Mar 11;367(9513):817-24
references.pmid: 16530575
references.citation: S Afr Med J. 2006 Apr;96(4):315-20
references.pmid: 16670804
references.citation: S Afr Med J. 2001 Jul;91(7):579-83
references.pmid: 11544974
references.citation: Bull World Health Organ. 2007 Jul;85(7):550-4
references.pmid: 17768504
references.citation: JAMA. 2006 Aug 16;296(7):782-93
references.pmid: 16905784
references.citation: AIDS. 2007 May 11;21(8):965-71
references.pmid: 17457090
references.citation: Cost Eff Resour Alloc. 2006 Dec 06;4:20
references.pmid: 17147833
references.citation: Antivir Ther. 2007;12(1):83-8
references.pmid: 17503751