Original articles

Monitoring the South African antiretroviral programme 2003-2007: The IeDEA Southern Africa collaboration

Morna Cornell, Karl Technau, Lara Fairall, Robin Wood, Harry Moultrie, Gilles Van Cutsem, Janet Giddy, Lerato Mohapi, Brian Eley, Patrick MacPhail, Hans Prozesky, Helena Rabie, Mary-Ann Davies, Nicola Maxwell, Andrew Boulle

Abstract


ABSTRACT
Objectives
To introduce the combined South African cohorts of the International Epidemiologic Databases to Evaluate AIDS-Southern Africa (IeDEA-SA) collaboration as reflecting the South African national antiretroviral treatment (ART) programme; to characterize patients accessing these services; and to describe changes in services and patients 2003-2007.

Design & setting
Multi-cohort study of 11 ART programmes in Gauteng, Western Cape, Free State and KwaZulu-Natal.

Subjects
ART-naïve adults and children (<16 years old) who initiated ART with ≥3 antiretroviral drugs before 2008.

Results
Most sites were offering free treatment to adults and children in the public sector, ranging from 264 to 17,835 patients per site. Among 45,383 adults and 6,198 children combined, median (IQR) range was 35.0 years (29.8-41.4) and 42.5 months (14.7-82.5) respectively. Of adults, 68% were female. Median CD4 cell count was 102 cells/µL (44-164) and was lower among males than females (86, 34-150 vs 110, 50-169, p<0.001). Median CD4% among children was 12% (7-17.7). Between 2003 and 2007, enrolment increased 11-fold in adults and 3-fold in children. Median CD4 count at enrolment increased for all adults (67-111 cells/µL, p<0.001) and for those in Stage IV (39-89 cells/µL, p<0.001). Among children <5 years, baseline CD4% increased over time (11.5%-16.0%, p<0.001).

Conclusions
IeDEA-SA provides a unique opportunity to report on the national ART programme. The study describes dramatically increasing enrolment. Late presentation, especially of men and children, remains a concern. Investment in sentinel sites ensures good individual-level data while freeing most sites to continue with simplified reporting.

Authors' affiliations

Morna Cornell, Infectious Disease Epidemiology Unit, School of Public Health & Family Medicine, University of Cape Town, South Africa; Perinatal HIV Research Unit, University of the Witwatersrand, Johannesburg

Karl Technau, University of Witwatersrand Paediatric HIV Clinics (Rahima Moosa Mother and Child Hospital, Johannesburg and Harriet Shezi Clinic, Chris Hani Baragwanath Hospital, Soweto)

Lara Fairall, Knowledge Translation Unit, University of Cape Town Lung Institute, Cape Town

Robin Wood, The Desmond Tutu HIV Centre, Institute for Infectious Disease & Molecular Medicine, University of Cape Town

Harry Moultrie, University of Witwatersrand Paediatric HIV Clinics (Harriet Shezi Clinic, Chris Hani Baragwanath Hospital, Soweto and Rahima Moosa Mother and Child Hospital, Johannesburg

Gilles Van Cutsem, Medecins Sans Frontieres, Khayelitsha, Cape Town; Infectious Disease Epidemiology Unit, School of Public Health & Family Medicine, University of Cape Town, Cape Town

Janet Giddy, McCord Hospital, Durban

Lerato Mohapi, Perinatal HIV Research Unit, University of the Witwatersrand, Johannesburg

Brian Eley, Red Cross Children’s Hospital, School of Child and Adolescent Health, University of Cape Town, Cape Town

Patrick MacPhail, Themba Lethu Clinic, Clinical HIV Research Unit, Department of Medicine, University of the Witwatersrand, Johannesburg

Hans Prozesky, Tygerberg Academic Hospital, University of Stellenbosch, Cape Town

Helena Rabie, Tygerberg Academic Hospital, University of Stellenbosch, Cape Town

Mary-Ann Davies, Infectious Disease Epidemiology Unit, School of Public Health & Family Medicine, University of Cape Town

Nicola Maxwell, Infectious Disease Epidemiology Unit, School of Public Health & Family Medicine, University of Cape Town

Andrew Boulle, Infectious Disease Epidemiology Unit, School of Public Health & Family Medicine, University of Cape Town

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Keywords

Epidemiology; national antiretroviral programme; surveillance

Cite this article

South African Medical Journal 2009;99(9):653.

Article History

Date submitted: 2009-04-20
Date published: 2009-09-02

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