Abstract
BackgroundIn 2015, Zimbabwe introduced third-line antiretroviral therapy (ART) through four designated treatment centers; three government clinics in Harare and Bulawayo, and Newlands Clinic (NC), operated by a private voluntary organization in Harare. We describe characteristics of patients receiving third line ART and analyzed treatment outcomes in this national programme as of 31 December 2018.MethodsWe described the population using proportions for categorical variables, and medians and interquartile ranges for continuous variables. Patients from NC, where data were more complete, were followed from the date of starting third-line ART until death, transfer, loss to follow up or 31 December 2018.ResultsA total of 209 patients had ever received third-line ART: 124 at NC and 85 from the three government clinics. HIV genotype results were available for 89 (72%) patients at NC and fourteen (16.5%) patients in the government clinics. Median duration of third line ART (years) in the government clinics was 2.3 (IQR:0.6–3.4), 1.3 (IQR: 0.7–1.7) and 1 (0.6–1.9). Of the 67 patients who received third line ART in the government clinics for at least six months, 53 (79%) had most recent viral load (VL) < 1000 copies/ml. Data on other treatment outcomes from government clinics were incomplete.From NC: a total of 109 (88%) patients were still in care, 13 (10.5%) had died and 2 (1.5%) were transferred. Median duration of third-line ART was 1.4 years (IQR: 0.6–2.8). Among the 111 NC patients who had received third-line ART for at least 6 months, 83 (75%) had a VL <50 copies/ml and 106 (95.5%) had a VL <1000 copies/ml.ConclusionOur findings demonstrate that, with comprehensive care, patients failing second-line ART can achieve high rates of virological suppression on third-line regimens. There is need to decentralize the provision of third-line ART in Zimbabwe. More needs to be done to improve completeness of data in the government clinics.
Highlights
In 2015, Zimbabwe introduced third-line antiretroviral therapy (ART) through four designated treatment centers; three government clinics in Harare and Bulawayo, and Newlands Clinic (NC), operated by a private voluntary organization in Harare
The median age at commencement of third-line ART ranged from 38 years (IQR: 20– 46.5) at Harare hospital to 48.7 years (IQR:43.7–50.7) at Parirenyatwa hospital
We summarize the results of the third-line ART programme in the 3 government linked clinics
Summary
We described the population using proportions for categorical variables, and medians and interquartile ranges for continuous variables. The study was conducted at the four designated national third-line ART treatment centers. Three of the centers are government run opportunistic infections (OI) clinics and the fourth center, NC, is operated and funded by a private foundation. Three of these centers, (Newlands Clinic, Harare Central Hospital and Parirenyatwa Central Hospital) are in the capital city, Harare. All four clinics use standard national HIV treatment guidelines for the care of patients. The clinic provides HIV genotyping, six monthly routine viral load monitoring, and other necessary laboratory and radiology services at no cost to the patient. Details of the model of care are published elsewhere [14]
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