title: Treatment outcomes after 7 years of public-sector HIV treatment.
abstract: OBJECTIVE
  To assess outcomes over the first 7 years of antiretroviral therapy (ART) at Themba Lethu Clinic, Johannesburg, South Africa.
  
  
  METHODS
  Observational cohort study.
  
  
  METHODS
  Patients are managed according to South African National Treatment Guidelines. Mortality is ascertained through linkage with the national vital registration system. Loss to follow-up is defined as at least 3 months late for the last scheduled appointment.
  
  
  RESULTS
  Between April 2004 and March 2010, 13 227 patients initiated ART, increasing from 1794 in the year 2004/2005 to 2481 in 2009/2010. Median CD4 cell count at ART initiation increased 39% between 2004 and 2009 (82 vs. 114 cells/ml). The proportion who died within 1 year on ART was below 11% at all time points, whereas the proportion lost by 1 year increased from 8.5% in 2004 to 12.1% in 2009 [risk ratio (RR) 1.42, 95% confidence interval (CI) 1.18–1.71]. We followed the 1794 patients initiated in April 2004 and March 2005 through August 2011 for 8172 person-years. We estimated 25% of patients were lost and 16% died. The overall mortality rate was 3.59 per 100 person-years (95% CI 3.20–4.02). Of the 1577 who completed at least 6 months of follow-up, 213 (13.5%) failed first-line treatment in a median (interquartile range) of 25.9 (15.8–41.4) months on treatment. Of those who failed, 141 (66.2%) switched to second-line for a rate of 48.5 per 100 person-years (95% CI 41.1–57.2).
  
  
  CONCLUSIONS
  Despite some improvements over 7 years, more intervention is needed in the first year on treatment to reduce overall attrition.
authors: Center for Global Health and Development, School of Public Health, Boston University, Boston, Massachusetts, USA. mfox@bu.edu
authors: Matthew P
authors: MP
authors: Fox
authors: Kate
authors: K
authors: Shearer
authors: Mhairi
authors: M
authors: Maskew
authors: William
authors: W
authors: Macleod
authors: Pappie
authors: P
authors: Majuba
authors: Patrick
authors: P
authors: Macphail
authors: Ian
authors: I
authors: Sanne
mesh_terms: D000163:Acquired Immunodeficiency Syndrome / Q000188:drug therapy* / Q000191:economics / Q000453:epidemiology; D000328:Adult; D019380:Anti-HIV Agents / Q000008:administration & dosage* / Q000191:economics; D018791:CD4 Lymphocyte Count; D015331:Cohort Studies; D005260:Female; D006078:Government Programs; D017408:Guidelines as Topic; D006801:Humans; D008297:Male; D008498:Medical Record Linkage; D015397:Program Evaluation; D017150:Public Sector; D012042:Registries; D013019:South Africa / Q000453:epidemiology; D016896:Treatment Outcome; D019562:Viral Load
chemical_list: D019380:Anti-HIV Agents