11th Conference on Retroviruses and Opportunistic Infections San Francisco, California - February 8 - 11, 2004

Conf Retroviruses Opportunistic Infect. 2004 Feb 8-11;11th:Abstract No. 2

Gavin Churchyard ¹, S Charalambous¹, A D Grant², L Pemba¹, D Martin³, R Wood⁴, J Sim³, R Chaisson⁴, and B A Brink^5
1Aurum Hlth Res, Anglo American, Welkom, South Africa; ²London Sch of Hygiene and Tropical Med; ³Toga Lab; ⁴Johns Hopkins Univ; and ⁵Anglo American Group Cos

BACKGROUND: The Anglo-American ART program was launched in November 2002 and uses standardized treatment regimens, data recording, and monitoring. The ART program is an extension of existing HIV prevention and care programs and uses guidelines derived from local and international best practice. ART is recommended for individuals with a CD4 count below 250 cells/mm³, WHO stage IV disease and WHO stage III disease with a CD4 count between 250 and 350 cells/mm³. The first-line regimen includes zidovudine, lamivudine, and efavirenz. The second-line regimen includes didanosine, abacavir, and lopinavir-ritonavir. Prophylaxis against opportunistic infections is also offered routinely. Laboratory and pharmacy services, using named-patient dispensing, are centralised. Counsellors, nurses, and doctors receive general and programme-specific training on HIV care. Doctors are supported by experienced HIV clinicians through telephone consultations and site visits. In the first year of the program 66 ART delivery sites were established in 7 provinces in South Africa. ART delivery sites include hospitals, urban and rural primary/occupational health care clinics.

METHODS: A total of 3094 HIV-infected individuals were enrolled on the program for HIV care of whom 1110 were eligible and 1058 (95%) accepted ART.

RESULTS: The median baseline viral load was 43,777 copies/mL and CD4 count was 148 cells/ L. At 6 weeks the mean increase in CD4 count was 72 cells/ L and 92% had a >1 log reduction in viral load. Results at 6 months will be presented. Perfect adherence (no tablets missed in the preceding 3 days) was reported at 92% of clinic visits. Although "adverse events" [any clinical event whether drug-related or not] occurred commonly (28% of patients), the majority (87%) were mild (grade 1 or 2). Serious adverse events resulting in hospitalisation or death occurred in 19 patients (1.8%). All-cause mortality was 3%. 92% of patients remain on ART.

CONCLUSIONS: The availability of ART has not stimulated a large increase in demand for VCT. In centers where capacity for rapid enrolment into the ART program exists, enrolment has been slower than anticipated. Obstacles to enrolment for ART need to be identified and addressed. This program provides a model for ART delivery in industrial settings in Africa.

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Copyright © 2004 - Foundation for Retrovirology and Human Health. Reproduction of this abstract (other than one copy for personal reference) must be cleared through the Foundation for Retrovirology and Human Health. Licensed (AIDSLINE) from National Library of Medicine.