Boulle Andrew, Bock Peter, Osler Meg, Cohen Karen, Channing Liezl, Hilderbrand Katherine, Mothibi Eula, Zweigenthal Virginia, Slingers Neviline, Cloete Keith, Abdullah Fareed
School of Public Health and Family Medicine, University of Cape Town, Cape Town, South Africa.
Bull World Health Organ. 2008 Sep;86(9):678-87. doi: 10.2471/blt.07.045294.
To describe province-wide outcomes and temporal trends of the Western Cape Province antiretroviral treatment (ART) programme 5 years since inception, and to demonstrate the utility of the WHO monitoring system for ART.
The treatment programme started in 2001 through innovator sites. Rapid scaling-up of ART provision began early in 2004, located predominantly in primary-care facilities. Data on patients starting ART were prospectively captured into facility-based registers, from which monthly cross-sectional activity and quarterly cohort reports were aggregated. Retention in care, mortality, loss to follow-up and laboratory outcomes were calculated at 6-monthly durations on ART.
By the end of March 2006, 16 234 patients were in care. The cohort analysis included 12 587 adults and 1709 children. Women accounted for 70% of adults enrolled. After 4 and 3 years on ART respectively, 72.0% of adults (95% confidence interval, CI: 68.0-75.6) and 81.5% (95% CI: 75.7-86.1) of children remained in care. The percentage of adults starting ART with CD4 counts less than 50 cells/microl fell from 51.3% in 2001 to 21.5% in 2005, while mortality at 6 months fell from 12.7% to 6.6%, offset in part by an increase in loss to follow-up (reaching 4.7% at 6 months in 2005). Over 85% of adults tested had viral loads below 400 copies/ml at 6-monthly durations until 4 years on ART.
The location of care in primary-care sites in this programme was associated with good retention in care, while the scaling-up of ART provision was associated with reduced early mortality.
描述西开普省抗逆转录病毒治疗（ART）项目自启动5年来全省范围内的治疗结果及时间趋势，并展示世界卫生组织ART监测系统的效用。
该治疗项目于2001年通过创新试点启动。2004年初开始迅速扩大ART服务规模，主要集中在初级保健机构。开始接受ART治疗的患者数据被前瞻性地录入基于机构的登记册，据此汇总每月的横断面活动数据和每季度的队列报告。在接受ART治疗6个月的时间段计算治疗留存率、死亡率、失访率和实验室检查结果。
到2006年3月底，有16234名患者正在接受治疗。队列分析包括12587名成人和1709名儿童。登记的成人中70%为女性。在接受ART治疗分别4年和3年后，72.0%的成人（95%置信区间，CI：68.0 - 75.6）和81.5%的儿童（95%CI：75.7 - 86.1）仍在接受治疗。开始接受ART治疗时CD4细胞计数低于50个/微升的成人比例从2001年的51.3%降至2005年的21.5%，而6个月时的死亡率从12.7%降至6.6%，部分被失访率的增加所抵消（2005年6个月时达到4.7%）。在接受ART治疗4年之前，每6个月接受检测的成人中超过85%的病毒载量低于400拷贝/毫升。
该项目在初级保健机构提供治疗与良好的治疗留存率相关，而扩大ART服务规模与降低早期死亡率相关。
