Marseille 2007
| Abstract #627 - Virological and Clinical outcomes of HIV-positive patients on antiretroviral therapy under different models of treatment and care in KwaZulu-Natal, South Africa | ||||
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Session: 26.103: Posters B (Poster) on Tuesday in Chaired by Authors: Presenting Author: Ms Anokhi Parikh - Univ. Of KwaZulu Natal, South Africa |
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| Additional Authors: Ms Maria de los Angeles Cabrera Escobar, Dr Victor Fredlund, Dr Janet Giddy, Ms Santhana Gengiah, Dr Marionette Holmes, Dr Helga Holst, Dr Umesh Lalloo, Dr Ric Marlink, Dr Douglas Ross, | ||||
| Aim: In response to the growing epidemic the South African government has been rapidly scaling up antiretroviral therapy (ART) with the goal of ultimately providing universal access to treatment. ART is being rolled-out in different setting using different approaches. Many unanswered questions remain about optimizing clinical outcomes of ART in South Africa utilizing different models of treatment and care. The aim of this paper is to investigate virological and clinical outcomes of adult patients on antiretroviral treatment under three different models of care across three sites in KwaZulu-Natal (KZN), South Africa. | ||||
| Method / Issue: Data were collected from retrospective chart reviews of 2400 adult patients enrolled on ART between July 2004 and July 2006. The sample of patients was selected from three ART providing hospitals/clinics in an urban, peri-urban and rural area using three different models of care. Each site's sample size was chosen to be proportional to the site's population size. Clinical and virological data in terms of CD4, viral load, mortality, treatment failure, opportunistic infections and changes in ART regimens were extracted from patient charts. Incidence of mortality, adverse ART reactions and opportunistic infections will be calculated and reported per patients years of follow up. Kaplan-Meier life-tables will be used to analyze the differences in survival outcomes at each of the sites. If statistically significant differences in survival are found using the above analytic techniques, multiple regression analysis will be performed to determine if these differences can be explained by confounding factors such as differences in demographics or initial health of the populations. | ||||
| Results / Comments: Data collection at all three sites is currently underway and will be completed in April 2007 and results from all three sites will be presented. Preliminary data from the urban site (McCord Hospital) from 349 patients indicates that the patient population is socio-economically disadvantaged, with 70% having some primary or secondary education. The mean age at the start of ART is 38 years. 58% of patients were female. Patients had a mean baseline CD4 count of 104.3, mean baseline viral load of 330,412 copies/ml. 92% of patients were alive at two years from start of treatment. The mean CD4 cell count at 6 months was 131.24. 77% of patients were started on a regimen of D4T-3TC-EFV. 31% percent of patients switched regimens,of which 67% changed regimens due to side effects. Mortality was 8% and for those who died the mean time to death was 13 months. | ||||
| Discussion: We hypothesize that there are no statistically significant differences in clinical outcomes (i.e. CD4 count levels, viral loads, time to death, incidence of opportunistic infection in specified CD4 count levels, incidence of serious adverse events within specified CD4 count levels, treatment failures, and regimen switches) across the sites. | ||||
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