Five-year experience with scaling-up access to antiretroviral treatment in an HIV care programme in Cambodia.
OBJECTIVE
To evaluate a 5-year HIV care programme (2003-2007) in the Sihanouk Hospital Center of HOPE, Phnom Penh, Cambodia.


METHODS
Analysis of routine programme indicators per year: number of new patients, active patients, antiretroviral therapy (ART) coverage in the cohort, mortality and loss to follow-up. Comparison of mortality before and after the start of ART using Kaplan-Meier survival curves. Analysis of risk factors using Cox regression for the combined endpoint of mortality and loss to follow-up in patients on ART.


RESULTS
3844 patients were registered in the hospital between March 2003 and December 2007. The mortality and loss to follow-up rate fell and paralleled the rise of ART coverage from 23% in 2003 to 90% in 2007. The mortality and the loss to follow-up rate was significantly higher in patients not on ART but eligible (Log rank P < 0.001). The combined endpoint of mortality and loss to follow-up was 48.7% after one year in patients who were waiting for ART. 1667 patients were started on ART. The combined endpoint (mortality and loss to follow-up) in this group was 11.5% at 12 months and 14.2% at 24 months. Risk factors for mortality in the ART group were male sex, CD4 count <50 cells/microl, BMI <18 and haemoglobin levels <10 g/dl.


CONCLUSIONS
Better access to ART is associated with lower mortality and fewer losses to follow-up. Pre-ART attrition remains significant. Strategies are needed to enable an earlier start of ART and to promote retention in care.
Thai
Sopheak
S
Infectious Disease Department, Sihanouk Hospital Center of HOPE, Phnom Penh, Cambodia. llynen@itg.be
Koole
Olivier
O
Un
Phally
P
Ros
Seilavath
S
De Munter
Paul
P
Van Damme
Wim
W
Jacques
Gary
G
Colebunders
Robert
R
Lynen
Lutgarde
L
D000293:Adolescent; D000328:Adult; D000368:Aged; D044966:Anti-Retroviral Agents / Q000008:administration & dosage / Q000600:supply & distribution*; D018791:CD4 Lymphocyte Count; D002160:Cambodia / Q000453:epidemiology; D015331:Cohort Studies; D004334:Drug Administration Schedule; D005260:Female; D015658:HIV Infections / Q000188:drug therapy* / Q000401:mortality; D015497:HIV-1; D006297:Health Services Accessibility; D006801:Humans; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D055815:Young Adult
D044966:Anti-Retroviral Agents