Outcomes of on-site antiretroviral therapy provision in a South African correctional facility.
We evaluated a novel on-site antiretroviral therapy (ART) programme in a South African correctional facility using routinely collected programme data, from a retrospective cohort of adult inmates starting ART between 03/2007 and 03/2009 followed-up to 09/2009. We report (1) mortality (using survival analysis); (2) retention in the programme (to 09/2009); and (3) virological suppression at six and 12 months (<400 copies/ml) following ART initiation. In total, 404 started ART (median age 33 years; 91.3% men; median baseline CD4 cell count 152 cells/µl [interquartile range 85-225]). Among 299 starting ART for the first time (ART-naïve), 23 deaths occurred during 252 person-years (median follow-up nine months). Mortality rates were 17.2 at 0-6 months (95% confidence interval 10.9-26.9) and 2.8 at >6 months (95% confidence interval 1.1-7.5)/100 person-years; p < 0.001. At 09/2009, 35.6% (144/404) remained in the correctional facility, with 94.4% (136/144) retained in the programme; 38.4% (155/404) were released; and 20.0% (81/404) transferred to another facility. ART-naïve patients in care six and 12 months after ART initiation, 94.7% (124/131) and 92.5% (74/80) were virologically suppressed, respectively. High early mortality warrants the early identification and management of HIV-positive inmates. The high mobility of inmates necessitates systems for facilitating continuity of care. Good virological responses and retention supports decentralising HIV care to correctional facilities.
The Aurum Institute, Johannesburg, South Africa lily.telisinghe@phe.gov.uk.|CAPRISA, University of KwaZulu-Natal, Durban, South Africa.
Lilanganee
L
Telisinghe
The Aurum Institute, Johannesburg, South Africa.
Piotr
P
Hippner
The Aurum Institute, Johannesburg, South Africa.|London School of Hygiene and Tropical Medicine, London, UK.|School of Public Health, University of Witwatersrand, Johannesburg, South Africa.
Gavin J
GJ
Churchyard
The Aurum Institute, Johannesburg, South Africa.
Gillian
G
Gresak
London School of Hygiene and Tropical Medicine, London, UK.
Alison D
AD
Grant
The Aurum Institute, Johannesburg, South Africa.|School of Public Health, University of Witwatersrand, Johannesburg, South Africa.
Salome
S
Charalambous
CAPRISA, University of KwaZulu-Natal, Durban, South Africa.
Katherine L
KL
Fielding
D000328:Adult; D019380:Anti-HIV Agents / Q000627:therapeutic use*; D023241:Antiretroviral Therapy, Highly Active; D018791:CD4 Lymphocyte Count; D003266:Continuity of Patient Care / Q000706:statistics & numerical data*; D005260:Female; D015658:HIV Infections / Q000175:diagnosis / Q000188:drug therapy* / Q000401:mortality; D006801:Humans; D008297:Male; D008403:Mass Screening / Q000706:statistics & numerical data; D011329:Prisoners / Q000706:statistics & numerical data; D011330:Prisons; D012189:Retrospective Studies; D013019:South Africa / Q000453:epidemiology; D016019:Survival Analysis; D016896:Treatment Outcome; D019562:Viral Load / Q000706:statistics & numerical data; D055815:Young Adult
D019380:Anti-HIV Agents
AIDS; HIV; antiretroviral therapy; correctional facilities; inmates; prisoners; treatment