title: Monitoring the South African National Antiretroviral Treatment Programme, 2003-2007: the IeDEA Southern Africa collaboration.
abstract: OBJECTIVE
  To introduce the combined South African cohorts of the International epidemiologic Databases to Evaluate AIDS Southern Africa (IeDEA-SA) collaboration as reflecting the South African national antiretroviral treatment (ART) programme; to characterise patients accessing these services; and to describe changes in services and patients from 2003 to 2007.
  
  
  METHODS
  Multi-cohort study of 11 ART programmes in Gauteng, Western Cape, Free State and KwaZulu-Natal.
  
  
  METHODS
  Adults and children (<16 years old) who initiated ART with > or =3 antiretroviral drugs before 2008.
  
  
  RESULTS
  Most sites were offering free treatment to adults and children in the public sector, ranging from 264 to 17,835 patients per site. Among 45,383 adults and 6,198 children combined, median age (interquartile range) was 35.0 years (29.8-41.4) and 42.5 months (14.7-82.5), respectively. Of adults, 68% were female. The median CD4 cell count was 102 cells/microl (44-164) and was lower among males than females (86, 34-150 v. 110, 50-169, p<0.001). Median CD4% among children was 12% (7-17.7). Between 2003 and 2007, enrolment increased 11-fold in adults and 3-fold in children. Median CD4 count at enrolment increased for all adults (67-111 cells/microl, p<0.001) and for those in stage IV (39-89 cells/microl, p<0.001). Among children <5 years, baseline CD4% increased over time (11.5-16.0%, p<0.001).
  
  
  CONCLUSIONS
  IeDEA-SA provides a unique opportunity to report on the national ART programme. The study describes dramatically increased enrolment over time. Late diagnosis and ART initiation, especially of men and children, need attention. Investment in sentinel sites will ensure good individual-level data while freeing most sites to continue with simplified reporting.
authors.affiliation: Infectious Disease Epidemiology Unit, School of Public Health and Family Medicine, University of Cape Town. morna@global.co.za
authors.forename: Morna
authors.initials: M
authors.lastname: Cornell
authors.forename: Karl
authors.initials: K
authors.lastname: Technau
authors.forename: Lara
authors.initials: L
authors.lastname: Fairall
authors.forename: Robin
authors.initials: R
authors.lastname: Wood
authors.forename: Harry
authors.initials: H
authors.lastname: Moultrie
authors.forename: Gilles
authors.initials: G
authors.lastname: van Cutsem
authors.forename: Janet
authors.initials: J
authors.lastname: Giddy
authors.forename: Lerato
authors.initials: L
authors.lastname: Mohapi
authors.forename: Brian
authors.initials: B
authors.lastname: Eley
authors.forename: Patrick
authors.initials: P
authors.lastname: MacPhail
authors.forename: Hans
authors.initials: H
authors.lastname: Prozesky
authors.forename: Helena
authors.initials: H
authors.lastname: Rabie
authors.forename: Mary-Ann
authors.initials: MA
authors.lastname: Davies
authors.forename: Nicola
authors.initials: N
authors.lastname: Maxwell
authors.forename: Andrew
authors.initials: A
authors.lastname: Boulle
mesh_terms: D000328:Adult; D044966:Anti-Retroviral Agents / Q000627:therapeutic use*; D002648:Child; D002675:Child, Preschool; D015331:Cohort Studies; D003153:Community Health Services / Q000458:organization & administration*; D016208:Databases, Factual; D005260:Female; D015658:HIV Infections / Q000188:drug therapy*; D006293:Health Promotion; D006297:Health Services Accessibility; D006801:Humans; D007223:Infant; D008297:Male; D008875:Middle Aged; D011159:Population Surveillance; D017410:Practice Guidelines as Topic; D015397:Program Evaluation; D013019:South Africa; D055815:Young Adult
chemical_list: D044966:Anti-Retroviral Agents