title: Outcomes of a remote, decentralized health center-based HIV/AIDS antiretroviral program in Zambia, 2003 to 2007.
abstract: A cross-sectional study of patients living with HIV/ AIDS treated during 2003 to 2007 in decentralized, rural health centers in Zambia was performed to measure virological outcomes after 12 months of antiretroviral therapy and identify factors associated with virological failure. Data from 228 patients who started antiretroviral therapy >12 months prior were analyzed. In all, 93% received stavudine + lamivudine + nevirapine regimens, and median antiretroviral therapy duration was 23.5 months (interquartile range 20-28). Of the 205 patients tested for viral load, 177 (86%) had viral load <1000 copies/mL. Probability of developing virological failure (viral load >1000 copies/mL) was 8.9% at 24 months and 19.6% at 32 months. Predictors for virological failure were <100% adherence, body mass index <18.5 kg/m(2), and women <40 years old. Of those with virological failure who underwent 3 to 6 months of intensive adherence counseling, 45% obtained virological success. In a remote, resource-limited setting in decentralized health centers, virological and immunological assessments of patients on antiretroviral therapy >12 months showed that positive health outcomes are achievable.
authors.affiliation: Médecins Sans Frontières-Holland, Amsterdam, The Netherlands.
authors.forename: Riekje
authors.initials: R
authors.lastname: Elema
authors.forename: Clair
authors.initials: C
authors.lastname: Mills
authors.forename: Oliver
authors.initials: O
authors.lastname: Yun
authors.forename: Kamalini
authors.initials: K
authors.lastname: Lokuge
authors.forename: Charles
authors.initials: C
authors.lastname: Ssonko
authors.forename: Nashiola
authors.initials: N
authors.lastname: Nyirongo
authors.forename: Velepi
authors.initials: V
authors.lastname: Mtonga
authors.forename: Henry
authors.initials: H
authors.lastname: Zulu
authors.forename: David
authors.initials: D
authors.lastname: Tu
authors.forename: Meggy
authors.initials: M
authors.lastname: Verputten
authors.forename: Daniel P
authors.initials: DP
authors.lastname: O'Brien
mesh_terms: D000328:Adult; D019380:Anti-HIV Agents / Q000494:pharmacology / Q000627:therapeutic use*; D044966:Anti-Retroviral Agents / Q000494:pharmacology / Q000627:therapeutic use; D018791:CD4 Lymphocyte Count; D003430:Cross-Sectional Studies; D004359:Drug Therapy, Combination; D005260:Female; D006678:HIV / Q000187:drug effects; D015658:HIV Infections / Q000188:drug therapy*; D006801:Humans; D019259:Lamivudine / Q000494:pharmacology / Q000627:therapeutic use*; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D019829:Nevirapine / Q000494:pharmacology / Q000627:therapeutic use*; D010349:Patient Compliance; D012307:Risk Factors; D019035:Rural Health Services; D018119:Stavudine / Q000494:pharmacology / Q000627:therapeutic use*; D016896:Treatment Outcome; D019562:Viral Load; D015024:Zambia
chemical_list: D019380:Anti-HIV Agents; D044966:Anti-Retroviral Agents; D019259:Lamivudine; D019829:Nevirapine; D018119:Stavudine