Evaluation of antiretroviral therapy (ART) provision in an early cohort of patients initiating ART in Ghana.
BACKGROUND
Against the background of Ghana's ART program which scaled up rapidly since inception in 2003, the study assessed outcomes of an early cohort of patients initiating ART.


METHODS
THE STUDY UTILIZED THE FOLLOWING METHODS: a cross-sectional study involving patient interviews using a structured questionnaire, a review of records and a retrospective cohort analysis of adults initiating ART between 2003 and 2008 from four selected clinics.


RESULTS
The 683 study participants consisted of 464 females (67.9%) and the mean age was 41 years. Mean duration of treatment was 25 months (SD =13). More than 95% were on a regimen as per national guidelines. Ninety-five (14.1%) of the respondents had one or two drugs substituted. Seventy-three% of the substitutions were due to adverse drug reactions. On at least one occasion, over half (350) had defaulted on a clinic appointment. In the 3 months preceding the survey, 21.4% (146) had missed treatment doses. About 49% (334) had challenges meeting financial obligations related to care. The median weight increased by 5.9 kg and 8.0 kg at 6 and 12 months after initiating ART respectively over the median baseline weight of 54 kg, (p-value = 0.001). The median CD4 count increased by 128, 170 and 256 cells/µl respectively at 6, 12 and 24 months from the median baseline of 125 cell/µl, (p-value = 0.035).


CONCLUSIONS
This study of Ghanaian PLHIV on ART from four facilities showed encouraging immunological and clinical outcomes. There were however issues of appointment default, sub-optimum adherence to treatment and cost of care barriers needing attention.
World Health Organization Ghana Country Office, Accra, Ghana.
Sally-Ann
SA
Ohene
National AIDS/STI Control Programme, Ghana Health Service, Accra, Ghana.
Nii Akwei
NA
Addo
Korle Bu Teaching Hospital, Accra, Ghana.
Francisca
F
Zigah
World Health Organization Inter-country Support Team, Harare, Zimbabwe.
Morkor
M
Newman
Department of Medicine, University of Ghana Medical School, Accra, Ghana.
Margaret
M
Lartey
St Dominic's Hospital, Akwatia, Ghana.
Maite Alfonso
MA
Romero
Koforidua Regional Hospital, Koforidua, Ghana.
Sampson
S
Ofori
Odorna Clinic, Accra, Ghana.
Tania
T
Sheriff
University of Ghana Dental School, Accra, Ghana.
Tom
T
Ndanu
D000328:Adult; D019380:Anti-HIV Agents / Q000191:economics / Q000627:therapeutic use*; D044966:Anti-Retroviral Agents / Q000191:economics / Q000627:therapeutic use*; D015331:Cohort Studies; D003430:Cross-Sectional Studies; D057915:Drug Substitution / Q000706:statistics & numerical data; D064420:Drug-Related Side Effects and Adverse Reactions / Q000453:epidemiology; D005260:Female; D005869:Ghana / Q000453:epidemiology; D015658:HIV Infections / Q000150:complications / Q000188:drug therapy* / Q000191:economics / Q000453:epidemiology; D015497:HIV-1; D006297:Health Services Accessibility / Q000191:economics / Q000706:statistics & numerical data; D006801:Humans; D008297:Male; D008875:Middle Aged; D010818:Practice Patterns, Physicians' / Q000706:statistics & numerical data*; D016903:Drug Monitoring
D019380:Anti-HIV Agents; D044966:Anti-Retroviral Agents
Ghana; antiretroviral treatment; clinical; immunological; outcomes