A novel HIV treatment model using private practitioners in South Africa
Published Date:Mar 2012
Source:Sex Transm Infect. 88(2):136-140.
Pubmed Central ID:PMC3724420
Funding:G0700837/Medical Research Council/United Kingdom
K23 AI083099/AI/NIAID NIH HHS/United States
U62 PS024055/PS/NCHHSTP CDC HHS/United States
AI083099/AI/NIAID NIH HHS/United States
The extent of the HIV epidemic in South Africa may render the public sector capacity inadequate to manage all patients requiring antiretroviral therapy (ART). Private practitioners are an underutilised resource that could be utilized to ease this challenge.
We developed a model of care using 72 private practitioners in five provinces in urban and rural areas of South Africa with centralised clinical support, training, pharmacy control and data management. We describe the programme, its quality control measures and patient outcomes using a cohort analysis.
Between January 2005 and December 2008, 9,102 individuals were started on ART, 63% female, mean age 35 years, median viral load 50,655 copies/ml and median baseline CD4 count 123 cells/μl. Retention (alive and in care) in those who started on ART after 12 months was 63% (5,743/9,102) in the 2005 cohort and did not change by calendar year. After 36 months, retention was 50% and 59%, for those enrolled in 2005 and 2006 respectively. The percentage virally suppressed remained similar over the cohorts at 6 months, 82% vs. 84%, 84% and 85% from 2005 - 2008, p=0.66; but improved slightly at 12 months, 78% vs. 83%, 83% and 84% from 2005 - 2008, p=0.05.
The results show that a well-managed private practitioner-based model can achieve comparable results to public service programmes, although long-term retention needs further evaluation. This model of ART delivery can be used to expand access to ART in areas where the public sector is unable to meet the demand.
image/gif image/jpeg application/octet-stream
You May Also Like: