Supporting the massive scale-up of antiretroviral therapy: the evolution of PEPFAR-supported treatment facilities in South Africa, 2005-2009

SUMMARYScale-up of antiretroviral therapy (ART) for human immunodeficiency virus (HIV) infection has reduced the incidence of pulmonary tuberculosis (PTB) in South Africa. Despite the strong association of HIV infection with extrapulmonary tuberculosis (EPTB), the effect of ART on the epidemiology of EPTB remains undocumented. We conducted a retrospective record review of patients initiated on treatment for EPTB in 2009 (ART coverage <5%) and 2013 (ART coverage 41%) at four public hospitals in rural Mopani District, South Africa. Data were obtained from TB registers and patients’ clinical records. There was a 13% decrease in overall number of TB cases, which was similar for cases registered as EPTB (n = 399 in 2009 vs. 336 in 2013; P < 0·01) and for PTB (1031 vs. 896; P < 0·01). Among EPTB cases, the proportion of miliary TB and disseminated TB decreased significantly (both P < 0·01), TB meningitis and TB of bones increased significantly (P < 0·01 and P = 0·02, respectively) and TB pleural effusion and lymphadenopathy remained the same. This study shows a reduction of EPTB cases that is similar to that of PTB in the context of the ART scale-up. The changing profile of EPTB warrants attention of healthcare workers.

Download Full-text

Perceived adherence barriers among patients failing second-line antiretroviral therapy in Khayelitsha, South Africa

Southern African Journal of HIV Medicine ◽

10.4102/sajhivmed.v14i4.51 ◽

2013 ◽

Vol 14 (4) ◽

pp. 166-169 ◽

Cited By ~ 11

Author(s):

W Barnett ◽

G Patten ◽

B Kerschberger ◽

K Conradie ◽

D B Garone ◽

...

Keyword(s):

South Africa ◽

Antiretroviral Therapy ◽

Service Delivery ◽

Scale Up ◽

Research Approach ◽

Second Line ◽

Access To Treatment ◽

Factors Affecting ◽

Art Initiation ◽

Resource Limited

Background. The recent scale-up of antiretroviral therapy (ART) coverage in resource-limited settings has greatly improved access to treatment. However, increasing numbers of patients are failing first- and second-line ART.Objective. To examine factors affecting adherence to second-line ART from the perspective of clinic staff and patients, assessing both individual and structural perceived barriers.Methods. Research was conducted at a large primary care tuberculosis (TB)/HIV clinic in Khayelitsha, a peri-urban township in Cape Town, South Africa. Participants were drawn from a Médecins Sans Frontières-run programme to support patients failing second-line ART. A qualitative research approach was used, combining multiple methodologies including key informant interviews with staff (n=11), in-depth interviews with patients (n=10) and a Photovoice workshop (n=11). Responses and photographs were coded by content; data were transformed into variables and analysed accordingly.Results. Staff identified drinking, non-disclosure, not using condoms and pill fatigue as barriers to ART adherence, while patients identified side-effects, not using condoms and a lack of understanding concerning medication timing. With respect to service delivery, staff identified a need for continued counselling and educational support following ART initiation. Patients were concerned about missing medical records and poor staff attitudes in the clinic.Conclusion. These findings identify discrepancies between provider and patient perceptions of barriers to, and facilitators of adherence, as well as of service delivery solutions. This highlights the need for on-going counselling and education following ART initiation, improved quality of counselling, and improved methods to identify and address specific barriers concerning medication adherence.

Download Full-text

High rates of retention and viral suppression in the scale-up of antiretroviral therapy adherence clubs in Cape Town, South Africa

Journal of the International AIDS Society ◽

10.7448/ias.20.5.21649 ◽

2017 ◽

Vol 20 ◽

pp. 21649 ◽

Cited By ~ 46

Author(s):

Priscilla Ruvimbo Tsondai ◽

Lynne Susan Wilkinson ◽

Anna Grimsrud ◽

Precious Thembekile Mdlalo ◽

Angelica Ullauri ◽

...

Keyword(s):

South Africa ◽

Antiretroviral Therapy ◽

Viral Suppression ◽

Scale Up ◽

Cape Town ◽

Therapy Adherence ◽

Antiretroviral Therapy Adherence

Download Full-text

China's Global and Domestic Governance of Climate Change, Trade and Sustainable Energy: Exploring China's Interests in a Global Massive Scale-Up of Renewable Energies

SSRN Electronic Journal ◽

10.2139/ssrn.2169844 ◽

2012 ◽

Cited By ~ 1

Author(s):

Ricardo Meléndez-Ortiz ◽

Joachim Monkelbaan ◽

George Riddell

Keyword(s):

Climate Change ◽

Sustainable Energy ◽

Scale Up ◽

Renewable Energies ◽

Massive Scale

Download Full-text

Experimental Investigations into the Use of Emergent Plants to Treat Sewage in South Africa

Water Science & Technology ◽

10.2166/wst.1987.0097 ◽

1987 ◽

Vol 19 (10) ◽

pp. 51-59 ◽

Cited By ~ 2

Author(s):

W. V. Alexander ◽

A. Wood

Keyword(s):

South Africa ◽

Rural Communities ◽

Experimental Investigations ◽

Artificial Wetlands ◽

E Coli ◽

Effluent Quality ◽

Emergent Plants ◽

Treatment Facilities ◽

High Standards ◽

Oxidation Ponds

South Africa is a relatively water-short country which has many rural communities with water-borne sewage infrastructures requiring low technology treatment facilities. In order to protect the water resources of the country the authorities have set high standards for effluent quality (COD < 75 mg/l, NH3 < 10 mg/l, E. coli < 1000 and in some areas P < 1 mg/l). Traditionally, oxidation ponds have been used in these applications but have not been able to consistently meet the required standards and recently interest has been shown in artificial wetlands as a low technology means of solving the problem. As a result several experimental projects are at present being initiated in South Africa, both as primary and secondary treatment for domestic sewage and also as a tertiary treatment to remove nitrogen, phosphorus and E. coli from conventional sewage plant effluents. The designs of these experimental projects are described in the paper and it is hoped that data will be available for presentation at the seminar.

Download Full-text

The effect of eligibility for antiretroviral therapy on body mass index and blood pressure in KwaZulu-Natal, South Africa

Scientific Reports ◽

10.1038/s41598-021-94057-z ◽

2021 ◽

Vol 11 (1) ◽

Author(s):

Aditi Kuber ◽

Anna Reuter ◽

Pascal Geldsetzer ◽

Natsayi Chimbindi ◽

Mosa Moshabela ◽

...

Keyword(s):

South Africa ◽

Blood Pressure ◽

Body Mass Index ◽

Antiretroviral Therapy ◽

Body Mass ◽

Treatment Guidelines ◽

Causal Effect ◽

Regression Discontinuity Design ◽

National Treatment ◽

Kwazulu Natal

AbstractWe use a regression discontinuity design to estimate the causal effect of antiretroviral therapy (ART) eligibility according to national treatment guidelines of South Africa on two risk factors for cardiovascular disease, body mass index (BMI) and blood pressure. We combine survey data collected in 2010 in KwaZulu-Natal, South Africa, with clinical data on ART. We find that early ART eligibility significantly reduces systolic and diastolic blood pressure. We do not find any significant effects on BMI. The effect on blood pressure can be detected up to three years after becoming eligible for ART.

Download Full-text

Community-based model for the delivery of antiretroviral therapy in Cambodia: a quasi-experimental study protocol

BMC Infectious Diseases ◽

10.1186/s12879-021-06414-y ◽

2021 ◽

Vol 21 (1) ◽

Author(s):

Sovannary Tuot ◽

Alvin Kuo Jing Teo ◽

Kiesha Prem ◽

Pheak Chhoun ◽

Chamroen Pall ◽

...

Keyword(s):

Experimental Study ◽

Antiretroviral Therapy ◽

Scale Up ◽

Economic Evaluations ◽

People Living With Hiv ◽

Cad Model ◽

Community Based ◽

Quasi Experimental ◽

Living With Hiv ◽

Art Delivery

Abstract Background Multi-month dispensing (MMD) is the mainstay mechanism for clinically stable people living with HIV in Cambodia to refill antiretroviral therapy (ART) every 3-6 months. However, less frequent ART dispensing through the community-based ART delivery (CAD) model could further reduce the clients’ and health facilities’ burden. While community-based services have been recognized as an integral component of HIV response in Cambodia, their role and effectiveness in ART delivery have yet to be systematically assessed. This study aims to evaluate the CAD model’s effectiveness on the continuum of care and treatment outcomes for stable people living with HIV in Cambodia. Methods We will conduct this quasi-experimental study in 20 ART clinics across the capital city and nine provinces between May 2021 and April 2023. Study sites were purposively selected based on the availability of implementing partners, the number of people living with HIV each clinic serves, and the accessibility of the clinics. In the intervention arm, approximately 2000 stable people living with HIV will receive ART and services from the CAD model. Another 2000 stable people living with HIV in the control arm will receive MMD—a standard care model for stable people living with HIV. The primary outcomes will be retention in care, viral load suppression, and adherence to ART. The secondary endpoints will include health providers’ work burden, the model’s cost-effectiveness, quality of life, mental health, social support, stigma, and discrimination. We will compare the outcome indicators within each arm at baseline, midline, and endline using descriptive and inferential statistics. We will evaluate the differences between the intervention and control arms using the difference-in-differences method. We will perform economic evaluations to determine if the intervention is cost-effective. Discussion This study will build the evidence base for future implementation and scale-up of CAD model in Cambodia and other similar settings. Furthermore, it will strengthen engagements with community stakeholders and further improve community mobilization, a vital pillar of the Cambodian HIV response. Trial registration ClinicalTrials.gov, NCT04766710. Registered 23 February 2021, Version 1.

Download Full-text