Barcelona 2013
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| Abstract #443 - E-Posters English | ||||
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Session: 50.119: E-Posters English (Poster) on Sunday in Chaired by Authors: Presenting Author: Mr. Thomas Riess - AIDS Healthcare Foundation, Netherlands |
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| Additional Authors: Dr. Jordi Casabona, Sra Cristina Sanclemente, Dra. Anna Esteve, Dra. Victoria Gonzalez, Grupo HIVITS TS, | ||||
| Aim: Throughout the world HIV positive individuals continue to present late for care and treatment, often coming to clinics when their CD4 levels are far below the threshold of antiretroviral therapy (ART) initiation. This late presentation by clients leads to increased morbidity and mortality and requires greater clinical management. This research set out to investigate how changes in Cambodia?s national treatment guidelines, from 2003 when treatment guidelines recommended initiating ART at 200 cells/mm3, to 250 cells/mm3 in 2007 and to 350 cells/mm3 in 2010, have influenced CD4 levels at which individuals are initiated on ART. | ||||
| Method / Issue: A retrospective cohort analysis was conducted with clients initiated on ART, from 2004 to 2011, at the Preah Kossomak HIV clinic in Phnom Penh, Cambodia. We analyzed client?s CD4 levels at ART initiation, stratified by year, to determine if there were increases in CD4 initiation levels over time. We included data from ART naïve patients. ART has been provided free of charge at the clinic since 2004. | ||||
| Results / Comments: Data from 2,440 adults were included in the analysis. A majority of clients were female (55.8%) and lived in Phnom Penh (71.9%), with an average age of 36 years. Findings show that CD4 levels at ART initiation increased over time, from an average 46.8 cells/mm3 [95% CI 38.7% - 54.8%] in 2004 to 258.3 cells/mm3 [95% CI 238.2 ? 278.4] in 2011. 250 clients were in pre-ART care for three months before initiating ART, with a majority of clients, 1,397 (57.3%) initiated within 12 months and 1,043 (42.7%) clients after 12 months. The death rate of clients six months after initiation decreased over time from. The average CD4 level of clients initiated on ART in all years is below the WHO recommended threshold. | ||||
| Discussion: Results show that increases in CD4 initiation levels had corresponding changes of when clients initiated ART. The initiation of ART earlier, i.e. at higher CD4 levels, coincided with reduced death rates. Despite WHO and national treatment guidelines findings show that most clients are initiated on treatment below recommended thresholds. Since a majority of clients in this cohort were in care for over 12 months before beginning ART, and that they began treatment with CD4 levels well below recommended treatment guidelines, it illustrates that clients aren?t necessarily enrolling in care late but are being initiated on treatment late. More attention needs to be given to clients during the pre-ART phase of care so that they are started on ART close to treatment threshold levels. | ||||
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