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Better Antiretroviral Therapy Outcomes at Primary Healthcare Facilities: An Evaluation of Three Tiers of ART Services in Four South African Provinces

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  • Geoffrey Fatti
  • Ashraf Grimwood
  • Peter Bock

Abstract

Background: There are conflicting reports of antiretroviral therapy (ART) effectiveness comparisons between primary healthcare (PHC) facilities and hospitals in low-income settings. This comparison has not been evaluated on a broad scale in South Africa. Methodology/Principal Findings: A retrospective cohort study was conducted including ART-naïve adults from 59 facilities in four provinces in South Africa, enrolled between 2004 and 2007. Kaplan-Meier estimates, competing-risks Cox regression, generalised estimating equation population-averaged models and logistic regression were used to compare death, loss to follow-up (LTFU) and virological suppression (VS) between PHC, district and regional hospitals. 29 203 adults from 47 PHC facilities, nine district hospitals and three regional hospitals were included. Patients at PHC facilities had more advanced WHO stage disease when starting ART. Retention in care was 80.1% (95% CI: 79.3%–80.8%), 71.5% (95% CI: 69.1%–73.8%) and 68.7% (95% CI: 67.0%–69.7%) at PHC, district and regional hospitals respectively, after 24 months of treatment (P

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  • Geoffrey Fatti & Ashraf Grimwood & Peter Bock, 2010. "Better Antiretroviral Therapy Outcomes at Primary Healthcare Facilities: An Evaluation of Three Tiers of ART Services in Four South African Provinces," PLOS ONE, Public Library of Science, vol. 5(9), pages 1-10, September.
    • Handle: RePEc:plo:pone00:0012888
    DOI: 10.1371/journal.pone.0012888
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    Cited by:

    1. Neely, Abigail H. & Ponshunmugam, Arunsrinivasan, 2019. "A qualitative approach to examining health care access in rural South Africa," Social Science & Medicine, Elsevier, vol. 230(C), pages 214-221.

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