Outcomes after two years of providing antiretroviral treatment in Khayelitsha, South Africa

TLDR

A community‑based ART programme launched in 2001 in Khayelitsha township aimed to assess operational challenges and prove feasibility of public‑sector HIV treatment in resource‑limited settings. The study sought to evaluate the operational feasibility of delivering ART in a public‑sector, resource‑limited township setting. The programme employed standardized protocols with generic drugs, a multidisciplinary team, and patient‑centred adherence support, enrolling 287 ART‑naïve adults followed for a median of 13.9 months. After 24 months, 86.3% of patients remained alive, 69.7% had undetectable viral loads, and only 15.1% required drug changes, demonstrating that ART can be delivered with high retention and favorable clinical outcomes in this setting.

Abstract

A community-based antiretroviral therapy (ART) programme was established in 2001 in a South African township to explore the operational issues involved in providing ART in the public sector in resource-limited settings and demonstrate the feasibility of such a service.Data was analysed on a cohort of patients with symptomatic HIV disease and a CD4 lymphocyte count < 200 x 10 cells/l. The programme used standardized protocols (using generic medicines whenever possible), a team-approach to clinical care and a patient-centred approach to promote adherence.Two-hundred and eighty-seven adults naive to prior ART were followed for a median duration of 13.9 months. The median CD4 lymphocyte count was 43 x 10 cells/l at initiation of treatment, and the mean log10 HIV RNA was 5.18 copies/ml. The HIV RNA level was undetectable (< 400 copies/ml) in 88.1, 89.2, 84.2, 75.0 and 69.7% of patients at 3, 6, 12, 18 and 24 months respectively. The cumulative probability of remaining alive was 86.3% at 24 months on treatment for all patients, 91.4% for those with a baseline CD4 lymphocyte count > or =50 x 10 cells/l, and 81.8% for those with a baseline CD4 lymphocyte count < 50 x 10 cells/l. The cumulative probability of changing a single antiretroviral drug by 24 months was 15.1% due to adverse events or contraindications, and 8.4% due to adverse events alone.ART can be provided in resource-limited settings with good patient retention and clinical outcomes. With responsible implementation, ART is a key component of a comprehensive response to the epidemic in those communities most affected by HIV.