Charalambous, Salome,Churchyard, Gavin J.,Fielding, Katherine,Grant, Alison,Hamilton, Robin,Innes, Craig,Kumaranayake, Lilani,Muirhead, Debbie,Pemba, Lindiwe
Objective: To review the experience of implementing a workplace HIV care programme in South Africa and describe treatment outcomes in sequential cohorts of individuals starting antiretroviral therapy (ART).
Design: A review of an industrial HIV care and treatment programme. Between October 2002 and December 2005, 2262 patients enrolled in the HIV care programme.
Results: CD4 cell counts increased by a median of 90, 113 and 164cells/mu l by 6, 12 and 24 months on treatment, respectively. The viral load was suppressed below 400 copies/ml in 75, 72 and 72% of patients at 6, 12 and 24 months, respectively, at an average cost of US$1654, 3567 and 7883 per patient virally suppressed, respectively. Treatment outcomes in sequential cohorts of patients were consistent overtime. A total of 93.6% of patients at 14752 clinic visits reported missing no tablets over the previous 3 days. Almost half the patients (46.8%) experienced one or more adverse events, although most were mild (78.7%). By the end of December 2005, 30% of patients were no longer on ART, mostly because of defaulted or stopped treatment (12.8%), termination of employment (8.2%), or death (4.9%). Conclusion: This large workplace programme achieved virological results among individuals retained in the programme comparable to those reported for developed countries; more work is needed to improve retention. Monitoring treatment outcomes in sequential cohorts is a useful way of monitoring programme performance. As the programme has matured, the costs of programme implementation have reduced.
Counselling is a central component of an ART programme. Challenges in implementing a workplace ART programme are similar to the challenges of public-sector programmes. (c) 2007 Lippincott Williams & Wilkins.
"ANTIRETROVIRAL THERAPY",COHORT,HIV,INDUSTRIAL,programmes,"VIRAL LOAD","ACTIVE ANTIRETROVIRAL THERAPY",MALAWI,"VIROLOGICAL RESPONSE"