title: Adult clinical and immunologic outcomes of the national antiretroviral treatment program in Rwanda during 2004-2005.
abstract: BACKGROUND
  By December 2007, over 48,000 persons had initiated antiretroviral treatment (ART) at 171 clinics in Rwanda. Assessing national ART program outcomes is essential to determine whether programs have the desired impact.
  
  
  METHODS
  We conducted a retrospective cohort study to assess key 6- and 12-month outcomes among a nationally representative, stratified, random sample of 3194 adults (> or =15 years) who initiated ART from January 1, 2004, through December 31, 2005.
  
  
  RESULTS
  At ART initiation, the median patient age was 37 years and 65% were female. Overall, the baseline median CD4 cell count was 141 cells per microliter. At 6 and 12 months after ART initiation, 92% and 86% of patients, respectively, remained on ART at their original site. By 6 months, 3.6% were dead and 3.4% were lost to follow-up; by 12 months, 4.6% were dead and 4.9% were lost to follow-up. Among patients with available follow-up CD4 cell count data, median CD4 cell counts increased by 98 cells per microliter and 119 cells per microliter at 6 and 12 months after ART initiation, respectively.
  
  
  CONCLUSIONS
  Rwanda's national ART program achieved excellent 6- and 12-month retention and immunologic outcomes during the first 2 years of rapid scale-up. Routine supervision is required to improve compliance with clinical guidelines and data quality.
authors.affiliation: Global AIDS Program, US Centers for Disease Control and Prevention, Kigali, Rwanda. lowrance@rw.cdc.gov
authors.forename: David W
authors.initials: DW
authors.lastname: Lowrance
authors.forename: Francois
authors.initials: F
authors.lastname: Ndamage
authors.forename: Eugenie
authors.initials: E
authors.lastname: Kayirangwa
authors.forename: Felix
authors.initials: F
authors.lastname: Ndagije
authors.forename: Wilson
authors.initials: W
authors.lastname: Lo
authors.forename: Donald R
authors.initials: DR
authors.lastname: Hoover
authors.forename: Jeff
authors.initials: J
authors.lastname: Hanson
authors.forename: Batya
authors.initials: B
authors.lastname: Elul
authors.forename: Aliou
authors.initials: A
authors.lastname: Ayaba
authors.forename: Tedd
authors.initials: T
authors.lastname: Ellerbrock
authors.forename: Alphonse
authors.initials: A
authors.lastname: Rukundo
authors.forename: Fabienne
authors.initials: F
authors.lastname: Shumbusho
authors.forename: Denis
authors.initials: D
authors.lastname: Nash
authors.forename: Jules
authors.initials: J
authors.lastname: Mugabo
authors.forename: Anita
authors.initials: A
authors.lastname: Assimwe
mesh_terms: D000328:Adult; D023241:Antiretroviral Therapy, Highly Active; D018791:CD4 Lymphocyte Count; D015331:Cohort Studies; D003906:Developing Countries; D005260:Female; D015658:HIV Infections / Q000188:drug therapy* / Q000276:immunology* / Q000821:virology; D015497:HIV-1; D006801:Humans; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D015397:Program Evaluation / Q000706:statistics & numerical data*; D011480:Protease Inhibitors / Q000627:therapeutic use; D012189:Retrospective Studies; D018894:Reverse Transcriptase Inhibitors / Q000627:therapeutic use; D012432:Rwanda; D016019:Survival Analysis; D016896:Treatment Outcome
chemical_list: D011480:Protease Inhibitors; D018894:Reverse Transcriptase Inhibitors