Monitoring and Outcomes of ART Programme Expansion WEAD1
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Type:
Oral Abstract Session Back
Venue: Session Room 4
Time: 11:00 - 12:30, 22.07.2009
Code: WEAD1
Chairs: Denis Nash, United States
Nagalingeswaran Kumarasamy, India
Session recording provided by International AIDS Society



Presentations in this session:

11:00
WEAD101
Abstract
Powerpoint		Changing characteristics of HIV-infected patients initiating antiretroviral therapy in East Africa from 2003-2008
Presented by Peter W. Hunt, United States
P.W. Hunt1, K. Wools-Kaloustian2, S. Kimaiyo3, L. Diero3, W.M. Tierney4, B.S. Musick4, P. Braitstein2, M.B. Bwana5, E. Geng6, D.R. Bangsberg7, J.N. Martin8, C.T. Yiannoutsos2
1University of California San Francisco, Internal Medicine, San Francisco, United States, 2Indiana University School of Medicine, Indianapolis, United States, 3Moi University School of Medicine, Eldoret, Kenya, 4University of Indiana, Indianapolis, United States, 5Mbarara University of Science and Technology, Mbarara, Uganda, 6University of California San Francisco, San Francisco, United States, 7Harvard University, Boston, United States, 8University of California San Francisco, San Francisco, United States

11:15
WEAD102
Abstract
Powerpoint		Who starts ART in Durban, South Africa?...Not everyone who should!
Presented by Ingrid Bassett, United States
I. Bassett1,2, S. Regan1, S. Chetty3, J. Giddy3, L. Uhler1, H. Holst3, D. Ross4, R. Walensky1,2, K. Freedberg1,2, E. Losina5,6
1Massachusetts General Hospital, General Medicine, Boston, United States, 2Harvard Medical School, Boston, United States, 3McCord Hospital, Durban, South Africa, 4St. Mary's Hospital, Durban, South Africa, 5Brigham and Women's Hospital, Boston, United States, 6Boston University School of Public Health, Boston, United States

11:30
WEAD103
Abstract
Powerpoint		Program-level determinants of low CD4 count ART initiation in cohorts of persons aged ≥ 6 years initiating ART in 8 sub-Saharan African countries
Presented by Denis Nash, United States
D. Nash1, Y. Wu1, S. Gandhi2, M. Manyasha3, R. Ntumy3, B. Elul1, W. El Sadr1, for the International Center for AIDS Care and Treatment Programs (ICAP)
1Columbia University - Mailman School of Public Health, International Center for AIDS Care and Treatment Programs (ICAP), New York, United States, 2Columbia University College of Physicians and Surgeons, Division of Infectious Diseases, New York, United States, 3International Center for AIDS Care and Treatment Programs (ICAP), Lesotho, Maseru, Lesotho

11:45
WEAD104
Abstract
Powerpoint		Scale up impact on care access and early program attrition: seven years of providing ART in rural Malawi
Presented by Megan McGuire, Malawi
M. Le Paih1, M. McGuire2, E. Szumilin3, A. Heinzelmann3, M. Pujades-Rodriguez4,5, A. Jahn6, K. Kamoto6, E. Schouten6, J. Mpunga6, E. Mbale7
1Médecins Sans Frontières, Blantyre, Malawi, 2Médecins Sans Frontières, Chiradzulu, Malawi, 3Médecins Sans Frontières, Paris, France, 4Epicentre, Paris, France, 5University of Bern (ISPM, Bern, Switzerland, 6Ministry of Health, HIV Unit, Lilongwe, Malawi, 7Ministry of Health, Chiradzulu District Hospital, Chiradzulu, Malawi

12:00
WEAD105
AbstractThis abstract has been enhanced with Abstract Plus!		A decline in early life mortality in a high HIV prevalence rural area of South Africa: associated with implementation of PMTCT and/or ART programmes?
Presented by James Ndirangu, South Africa
J. Ndirangu, R. Bland, M.-L. Newell
Africa Center for Health and Population Studies, UKZN, Durban, South Africa

Powerpoints presentations
Changing characteristics of HIV-infected patients initiating antiretroviral therapy in East Africa from 2003-2008 - Hunt

Who starts ART in Durban, South Africa?...Not everyone who should! - Bassett

Program-level determinants of low CD4 count ART initiation in cohorts of persons aged ≥ 6 years initiating ART in 8 sub-Saharan African countries - Nash

Scale up impact on care access and early program attrition: seven years of providing ART in rural Malawi - McGuire




Rapporteur report

Track D report by David Coetzee


 

Session:  The session discussed factors related to entry into ART care and individual and programme outcomes as a result of the provision of ART and/or PMTCT.

 

The profile of patients initiating ART since 1998 in East Africa has changed.  Free services since 2004 have led to increases in the number on ART and clinics offering ART.  The proportion of Stage I and II patients and of women initiating ART has increased, while the median age has decreased.  Men were more likely to initiate late, with no change over time.  Median CD4 counts have increased at initiation. Increased numbers of clinics over time correlated with decreased travel times to ART facilities.

 

In Durban, South Africa patients attending 2 health services were screened for HIV. There was substantial attrition of infected persons with only half of those eligible being placed on ART. There was a long delay between time of diagnosis and initiation. Predictors of attrition included male sex, low CD4 and having no other friend or family member infected with HIV.

 

Quarterly PEPFAR cohort data were analysed from 267 ICAP sites in Africa to identify programme level determinants of low CD4 ART initiation. The median CD4 was 136. Countries with higher HIV prevalence, services that lacked outreach adherence support, without CD4 availability on site, and urban services were characterized by having patients with lower CD4s at start of ART.

 

The MSF ART programme in Malawi showed that in a mostly rural area, decentalisation to 10 health services run by nurses led to earlier patient access to ART, greater numbers placed on ART, a decline in early mortality on ART and improved retention over time, particularly for children.

 

Temporal and spatial demographic surveillance has shown that under 2 mortality has declined since the introduction of the PMTCT and paediatric ART programmes in a high HIV prevalence rural area of KwaZulu/Natal in South Africa. 

 

Conclusion:  The decentralization of services and, related, improved access to ART services has leads to more favourable clinical outcomes.




   

   

    The organizers reserve the right to amend the programme.
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