Adult clinical and immunologic outcomes of the national antiretroviral treatment program in Rwanda during 2004-2005.
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.
Lowrance
David W
DW
Global AIDS Program, US Centers for Disease Control and Prevention, Kigali, Rwanda. lowrance@rw.cdc.gov
Ndamage
Francois
F
Kayirangwa
Eugenie
E
Ndagije
Felix
F
Lo
Wilson
W
Hoover
Donald R
DR
Hanson
Jeff
J
Elul
Batya
B
Ayaba
Aliou
A
Ellerbrock
Tedd
T
Rukundo
Alphonse
A
Shumbusho
Fabienne
F
Nash
Denis
D
Mugabo
Jules
J
Assimwe
Anita
A
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
D011480:Protease Inhibitors; D018894:Reverse Transcriptase Inhibitors