Abstract
Objective. To describe and evaluate the outcomes of a support programme for patients with virological failure while receiving second-line antiretroviral therapy (ART) in South Africa. Method. We described a comprehensive medical and counselling patient support programme for patients receiving secondline ART and with two consecutive viral loads (VLs) >1 000 copies/ml. Patients with >3 months follow-up and at least one VL measurement after inclusion in the programme were eligible for analysis. Results. Of 69 patients enrolled in the programme, 40 had at least one follow-up VL and no known drug resistance at enrolment; 27 (68%) of these re-suppressed while remaining on second-line ART following enhanced adherence support. The majority (18/27; 67%) achieved re-suppression within the first 3 months in the programme. Five patients with diagnosed second-line drug resistance achieved viral re-suppression (<400 copies/ml) after being switched to third-line ART. Seven patients (7/40; 18%) did not achieve viral re-suppression after 9 months in the programme: 6 with known adherence problems (4 without drug resistance on genotype) and 1 with a VL <1 000 copies/ml. Overall, 3 patients (4%) died, 3 (4%) were lost to follow-up and 2 (3%) were transferred out. Conclusion. Our experience from a routine programme demonstrates that with targeted adherence support, the majority of patients who were viraemic while receiving second-line ART returned to an undetectable VL within 3 months. By increasing the time receiving second-line ART and decreasing the need for genotypes and/or third-line ART, this intervention may reduce costs.
Highlights
We described a comprehensive medical and counselling patient support programme for patients receiving secondline antiretroviral therapy (ART) and with two consecutive viral loads (VLs) >1 000 copies/ml
We described the treatment and VL history of patients during the study period with frequencies for categorical variables and medians and interquartile ranges (IQRs) for continuous variables
From January to December 2011, a total of 69 patients were enrolled in the programme (Fig. 2); 29 were excluded from the analysis
Summary
Khayelitsha sub-district (population ~500 000 inhabitants) is located on the outskirts of Cape Town, SA, and has one of the highest burdens of HIV and tuberculosis (TB) in the country. The Khayelitsha programme was the first in SA to provide ART at the primary care level in the public sector. The programme was established in 2001 by Médecins Sans Frontières (MSF) and the Provincial Government of the Western Cape (PGWC) and has been described previously.[8,12,19] MSF’s role evolved from the provision of first-line ART to piloting models of primary care for drug-resistant tuberculosis (DR-TB), longterm ART and vulnerable groups such as children, youth, pregnant women and men. By the end of 2011, over 20 000 patients remained in ART care provided by the Department of Health in Khayelitsha.[12]
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