Abstract
BackgroundAlthough South Africa has the largest public-sector anti-retroviral treatment (ART) programme in the world, anti-retroviral coverage in adults was only 40.2% in 2008. However, longitudinal studies of who is accessing the South African public-sector ART programme are scarce. This study therefore had one main research question: who is accessing public-sector ART in the Free State Province, South Africa? The study aimed to extend the current literature by investigating, in a quantitative manner and using a longitudinal study design, the participants enrolled in the public-sector ART programme in the period 2004-2006 in the Free State Province of South Africa.MethodsDifferences in the demographic (age, sex, population group and marital status) socio-economic (education, income, neo-material indicators), geographic (travel costs, relocation for ART), and medical characteristics (CD4, viral load, time since first diagnosis, treatment status) among 912 patients enrolled in the Free State public-sector ART programme between 2004 and 2006 were assessed with one-way analysis of variance, Bonferroni post-hoc analysis, and cross tabulations with the chi square test.ResultsThe patients accessing treatment tended to be female (71.1%) and unemployed (83.4%). However, although relatively poor, those most likely to access ART services were not the most impoverished patients. The proportion of female patients increased (P < 0.05) and their socio-economic situation improved between 2004 and 2006 (P < 0.05). The increasing mean transport cost (P < 0.05) to visit the facility is worrying, because this cost is an important barrier to ART uptake and adherence. Encouragingly, the study results revealed that the interval between the first HIV-positive diagnosis and ART initiation decreased steadily over time (P < 0.05). This was also reflected in the increasing baseline CD4 cell count at ART initiation (P < 0.05).ConclusionsOur analysis showed significant changes in the demographic, socio-economic, geographic, and medical characteristics of the patients during the first three years of the programme. Knowledge of the characteristics of these patients can assist policy makers in developing measures to retain them in care. The information reported here can also be usefully applied to target patient groups that are currently not reached in the implementation of the ART programme.
Highlights
South Africa has the largest public-sector anti-retroviral treatment (ART) programme in the world, anti-retroviral coverage in adults was only 40.2% in 2008
The information reported here can be usefully applied to target patient groups that are currently not reached in the implementation of the ART programme
In 2007, the human immunodeficiency virus (HIV) & acquired immunodeficiency syndrome (AIDS) and STI National Strategic Plan (NSP) 2007-2011 re-affirmed this emphasis on treatment by adopting as its two primary aims to reduce new HIV infections by 50%, through the prevention of mother-to-child transmission (PMTCT), and to reduce the impact of the epidemic by extending access to appropriate treatment, care, and support to 80% of people diagnosed with HIV [3]
Summary
South Africa has the largest public-sector anti-retroviral treatment (ART) programme in the world, anti-retroviral coverage in adults was only 40.2% in 2008. Longitudinal studies of who is accessing the South African public-sector ART programme are scarce. This study had one main research question: who is accessing public-sector ART in the Free State Province, South Africa? The study aimed to extend the current literature by investigating, in a quantitative manner and using a longitudinal study design, the participants enrolled in the public-sector ART programme in the period 2004-2006 in the Free State Province of South Africa. Preliminary research results showed that ART provided by the South African government health services is as effective as that provided in high-income countries [4]. Studies of the ART programme outcomes have indicated that South Africa ranks among the top African countries in patient survival and retention rates [11,12]. Despite severe human resource shortages, health personnel provide high-quality care, which results in high levels of patient satisfaction with ART-related services [13,14,15]
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