Monitoring the South African National Antiretroviral Treatment Programme, 2003-2007: the IeDEA Southern Africa collaboration.
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.
Cornell
Morna
M
Infectious Disease Epidemiology Unit, School of Public Health and Family Medicine, University of Cape Town. morna@global.co.za
Technau
Karl
K
Fairall
Lara
L
Wood
Robin
R
Moultrie
Harry
H
van Cutsem
Gilles
G
Giddy
Janet
J
Mohapi
Lerato
L
Eley
Brian
B
MacPhail
Patrick
P
Prozesky
Hans
H
Rabie
Helena
H
Davies
Mary-Ann
MA
Maxwell
Nicola
N
Boulle
Andrew
A
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
D044966:Anti-Retroviral Agents