title: Antiretroviral outcomes in South African prisoners: a retrospective cohort analysis.
abstract: METHODS
  Little is known about antiretroviral therapy (ART) outcomes in prisoners in Africa. We conducted a retrospective review of outcomes of a large cohort of prisoners referred to a public sector, urban HIV clinic. The review included baseline characteristics, sequential CD4 cell counts and viral load results, complications and co-morbidities, mortality and loss to follow-up up to 96 weeks on ART.
  
  
  RESULTS
  148 inmates (133 male) initiated on ART were included in the study. By week 96 on ART, 73% of all inmates enrolled in the study and 92% of those still accessing care had an undetectable viral load (<400 copies/ml). The median CD4 cell count increased from 122 cells/mm(3) at baseline to 356 cells/mm(3) by 96 weeks. By study end, 96 (65%) inmates had ever received tuberculosis (TB) therapy with 63 (43%) receiving therapy during the study: 28% had a history of TB prior to ART initiation, 33% were on TB therapy at ART initiation and 22% developed TB whilst on ART. Nine (6%) inmates died, 7 in the second year on ART. Loss to follow-up (LTF) was common: 14 (9%) patients were LTF whilst still incarcerated, 11 (7%) were LTF post-release and 9 (6%) whose movements could not be traced. 16 (11%) inmates had inter-correctional facility transfers and 34 (23%) were released of whom only 23 (68%) returned to the ART clinic for ongoing follow-up.
  
  
  CONCLUSIONS
  Inmates responded well to ART, despite a high frequency of TB/HIV co-infection. Attention should be directed towards ensuring eligible prisoners access ART programs promptly and that inter-facility transfers and release procedures facilitate continuity of care. Institutional TB control measures should remain a priority.
authors.affiliation: Division of Infectious Disease, Department of Medicine, Chris Hani Baragwanath Hospital and Wits Reproductive Health and HIV Institute, University of the Witwatersrand, Johannesburg, South Africa. ndavies@wrhi.ac.za
authors.forename: Natasha E C G
authors.initials: NE
authors.lastname: Davies
authors.forename: Alan S
authors.initials: AS
authors.lastname: Karstaedt
mesh_terms: D000328:Adult; D019380:Anti-HIV Agents / Q000627:therapeutic use*; D000995:Antitubercular Agents / Q000627:therapeutic use; D018791:CD4 Lymphocyte Count; D015331:Cohort Studies; D005260:Female; D015658:HIV Infections / Q000188:drug therapy* / Q000401:mortality; D006801:Humans; D008297:Male; D008875:Middle Aged; D011329:Prisoners; D012189:Retrospective Studies; D013019:South Africa; D016896:Treatment Outcome; D014376:Tuberculosis / Q000150:complications / Q000188:drug therapy; D019562:Viral Load; D055815:Young Adult
chemical_list: D019380:Anti-HIV Agents; D000995:Antitubercular Agents