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Five‐year experience with scaling‐up access to antiretroviral treatment in an HIV care programme in Cambodia
Author(s) -
Thai Sopheak,
Koole Olivier,
Un Phally,
Ros Seilavath,
De Munter Paul,
Van Damme Wim,
Jacques Gary,
Colebunders Robert,
Lynen Lutgarde
Publication year - 2009
Publication title -
tropical medicine and international health
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.056
H-Index - 114
eISSN - 1365-3156
pISSN - 1360-2276
DOI - 10.1111/j.1365-3156.2009.02334.x
Subject(s) - medicine , antiretroviral therapy , proportional hazards model , cohort , mortality rate , human immunodeficiency virus (hiv) , survival analysis , demography , attrition , clinical endpoint , viral load , clinical trial , family medicine , dentistry , sociology
Summary Objectives To evaluate a 5‐year HIV care programme (2003–2007) in the Sihanouk Hospital Center of HOPE, Phnom Penh, Cambodia. Methods Analysis of routine programme indicators per year: number of new patients, active patients, antiretroviral therapy (ART) coverage in the cohort, mortality and loss to follow‐up. Comparison of mortality before and after the start of ART using Kaplan–Meier survival curves. Analysis of risk factors using Cox regression for the combined endpoint of mortality and loss to follow‐up in patients on ART. Results 3844 patients were registered in the hospital between March 2003 and December 2007. The mortality and loss to follow‐up rate fell and paralleled the rise of ART coverage from 23% in 2003 to 90% in 2007. The mortality and the loss to follow‐up rate was significantly higher in patients not on ART but eligible (Log rank P < 0.001). The combined endpoint of mortality and loss to follow‐up was 48.7% after one year in patients who were waiting for ART. 1667 patients were started on ART. The combined endpoint (mortality and loss to follow‐up) in this group was 11.5% at 12 months and 14.2% at 24 months. Risk factors for mortality in the ART group were male sex, CD4 count <50 cells/μl, BMI <18 and haemoglobin levels <10 g/dl. Conclusion Better access to ART is associated with lower mortality and fewer losses to follow‐up. Pre‐ART attrition remains significant. Strategies are needed to enable an earlier start of ART and to promote retention in care.