Page 275 - SAHCS HIVMed Journal Vol 20 No 1 2019

Southern African Journal of HIV Medicine
ISSN: (Online) 2078-6751, (Print) 1608-9693
Page 1 of 10 Original Research

Baseline CD4 and mortality trends in the South African

human immunodeficiency virus programme:

Analysis of routine data

Authors: Background: Despite widespread availability of antiretroviral therapy (ART) in South Africa,
Rivka R. Lilian there remains a considerable burden of human immunodeficiency virus (HIV)-related
1
Kate Rees
1,2
Moyahabo Mabitsi morbidity and mortality.
1
James A. McIntyre Objectives: To describe ART initiation and outcome trends over time, with a focus on clients
1,2
Helen E. Struthers
1,3
Remco P.H. Peters 1,4,5 presenting with advanced HIV-infection, so as to identify interventions to reduce morbidity
and mortality.
Affiliations:
1 Anova Health Institute, Methods: Routine TIER.Net data from HIV-infected adults who had a documented baseline
Johannesburg, South Africa CD4 count and were newly initiating ART in Johannesburg or Mopani districts from 2004 to
2017 were analysed. Trends in baseline CD4 count and 5-year mortality were investigated and
2 School of Public Health and the population initiating ART with CD4 < 200 cells/mm was described.
3
Family Medicine, University
of Cape Town, Cape Town, Results: The Johannesburg and Mopani data sets comprised 203 131 and 101 814 records,
South Africa respectively. Although median CD4 count increased over time, the proportion of initiations at
3
3 Division of Infectious CD4 < 200 cells/mm in 2017 remained high (Johannesburg 39%, Mopani 35%). Mortality was
Diseases and HIV Medicine, significantly increased among clients with CD4 < 200 compared to those with higher baseline
Department of Medicine, counts (p < 0.001). Even though mortality among clients with low CD4 declined over time,
University of Cape Town, likely because of improved drug regimens, in 2016–2017 mortality was still significantly
Cape Town, South Africa
increased among these clients (p < 0.001). Delivery of cotrimoxazole prophylaxis to clients
with low CD4 declined over time to < 30% in 2017 and was associated with clinical stage.
4 School of Public Health,
3
University of the Presentation with CD4 < 200 cells/mm was associated with older age, male gender and
Witwatersrand, hospitalisation.
Johannesburg, South Africa
Conclusion: A concerningly large proportion of South Africans still initiate ART at low CD4
5 Department of Medical counts. This is associated with increased mortality and requires targeted interventions to
Microbiology, School of improve delivery of prophylactic regimens and early engagement in care.
Public Health and Primary
Care (CAPHRI), Maastricht Keywords: TIER.Net; Antiretroviral Therapy; CD4; Mortality; HIV; South Africa.
University Medical Centre,
Maastricht, the Netherlands
Introduction
Corresponding author:
Remco Peters, In 2017, there were 6.9 million adults living with human immunodeficiency virus (HIV) in South
[email protected]
Africa, of whom 61% were receiving treatment. This equates to 4.2 million adults receiving
1
Dates: antiretroviral therapy (ART), forming the largest treatment programme in the world. South
1
Received: 05 Mar. 2019 Africa’s ART programme has demonstrated successful initiation and management of clients on
Accepted: 11 Apr. 2019 treatment for over a decade, despite rapid programmatic scale-up over this time, and has
2
Published: 24 July 2019
achieved near-normal life expectancy for HIV-infected adults with timely ART initiation. The
3
ART programme is thus an essential component of the third Sustainable Development Goal which
aims to ensure healthy lives and end the AIDS epidemic by 2030. 4
South Africa’s ART programme has evolved over time to accommodate increasing numbers
of HIV-infected clients and to provide improved care and treatment services (Table 1). 5,6,7,8,9,10
This has encompassed expansion of the ART eligibility criteria from clients with CD4 counts
< 200 cells/mm in 2004 to universal test and treat (UTT) in 2016, as well as a shift from doctor-
5
3
8
to nurse-managed care and decentralisation of ART services from hospitals to primary healthcare
11
Read online: sites. Across all years, cotrimoxazole preventive therapy (CPT) has been recommended for
Read online:
Scan this QR
Scan this QR clients with baseline CD4 counts below 200 cells/mm as a means of protecting against infections
3
code with your
code with your
smart phone or
smart phone or
mobile device How to cite this article: Lilian RR, Rees K, Mabitsi M, et al. Baseline CD4 and mortality trends in the South African human immunodeficiency
mobile device
to read online. virus programme: Analysis of routine data. S Afr J HIV Med. 2019;20(1), a963. https://doi.org/10.4102/sajhivmed.v20i1.963
to read online.
Copyright: © 2019. The Authors. Licensee: AOSIS. This work is licensed under the Creative Commons Attribution License.
http://www.sajhivmed.org.za 268 Open Access