title: Who is accessing public-sector anti-retroviral treatment in the Free State, South Africa? An exploratory study of the first three years of programme implementation.
abstract: BACKGROUND
  Although South Africa has the largest public-sector anti-retroviral treatment (ART) programme in the world, anti-retroviral coverage in adults was only 40.2% in 2008. However, longitudinal studies of who is accessing the South African public-sector ART programme are scarce. This study therefore had one main research question: who is accessing public-sector ART in the Free State Province, South Africa? The study aimed to extend the current literature by investigating, in a quantitative manner and using a longitudinal study design, the participants enrolled in the public-sector ART programme in the period 2004-2006 in the Free State Province of South Africa.
  
  
  METHODS
  Differences in the demographic (age, sex, population group and marital status) socio-economic (education, income, neo-material indicators), geographic (travel costs, relocation for ART), and medical characteristics (CD4, viral load, time since first diagnosis, treatment status) among 912 patients enrolled in the Free State public-sector ART programme between 2004 and 2006 were assessed with one-way analysis of variance, Bonferroni post-hoc analysis, and cross tabulations with the chi square test.
  
  
  RESULTS
  The patients accessing treatment tended to be female (71.1%) and unemployed (83.4%). However, although relatively poor, those most likely to access ART services were not the most impoverished patients. The proportion of female patients increased (P < 0.05) and their socio-economic situation improved between 2004 and 2006 (P < 0.05). The increasing mean transport cost (P < 0.05) to visit the facility is worrying, because this cost is an important barrier to ART uptake and adherence. Encouragingly, the study results revealed that the interval between the first HIV-positive diagnosis and ART initiation decreased steadily over time (P < 0.05). This was also reflected in the increasing baseline CD4 cell count at ART initiation (P < 0.05).
  
  
  CONCLUSIONS
  Our analysis showed significant changes in the demographic, socio-economic, geographic, and medical characteristics of the patients during the first three years of the programme. Knowledge of the characteristics of these patients can assist policy makers in developing measures to retain them in care. The information reported here can also be usefully applied to target patient groups that are currently not reached in the implementation of the ART programme.
authors.affiliation: Department of Sociology and Research Centre for Longitudinal and Life Course Studies, University of Antwerp, Sint-Jacob Street 2, 2000 Antwerp, Belgium. edwin.wouters@ua.ac.be
authors.forename: Edwin
authors.initials: E
authors.lastname: Wouters
authors.forename: Christo
authors.initials: C
authors.lastname: Heunis
authors.forename: Koen
authors.initials: K
authors.lastname: Ponnet
authors.forename: Francis
authors.initials: F
authors.lastname: Van Loon
authors.forename: Frederik le Roux
authors.initials: Fle R
authors.lastname: Booysen
authors.forename: Dingie
authors.initials: D
authors.lastname: van Rensburg
authors.forename: Herman
authors.initials: H
authors.lastname: Meulemans
mesh_terms: D000328:Adult; D000704:Analysis of Variance; D044966:Anti-Retroviral Agents / Q000627:therapeutic use*; D018791:CD4 Lymphocyte Count; D003151:Community Health Centers / Q000706:statistics & numerical data*; D005260:Female; D015658:HIV Infections / Q000188:drug therapy*; D006801:Humans; D008137:Longitudinal Studies; D008297:Male; D015397:Program Evaluation; D017150:Public Sector; D012737:Sex Factors; D012959:Socioeconomic Factors; D013019:South Africa; D019562:Viral Load
chemical_list: D044966:Anti-Retroviral Agents