Antiretroviral Outcomes in South African Prisoners: A Retrospective Cohort AnalysisReportar como inadecuado




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Background and Methods

Little is known about antiretroviral therapy ART outcomes in prisoners in Africa. We conducted a retrospective review of outcomes of a large cohort of prisoners referred to a public sector, urban HIV clinic. The review included baseline characteristics, sequential CD4 cell counts and viral load results, complications and co-morbidities, mortality and loss to follow-up up to 96 weeks on ART.

Findings

148 inmates 133 male initiated on ART were included in the study. By week 96 on ART, 73% of all inmates enrolled in the study and 92% of those still accessing care had an undetectable viral load <400copies-ml. The median CD4 cell count increased from 122 cells-mm3 at baseline to 356 cells-mm3 by 96 weeks. By study end, 96 65% inmates had ever received tuberculosis TB therapy with 63 43% receiving therapy during the study: 28% had a history of TB prior to ART initiation, 33% were on TB therapy at ART initiation and 22% developed TB whilst on ART. Nine 6% inmates died, 7 in the second year on ART. Loss to follow-up LTF was common: 14 9% patients were LTF whilst still incarcerated, 11 7% were LTF post-release and 9 6% whose movements could not be traced. 16 11% inmates had inter-correctional facility transfers and 34 23% were released of whom only 23 68% returned to the ART clinic for ongoing follow-up.

Conclusions

Inmates responded well to ART, despite a high frequency of TB-HIV co-infection. Attention should be directed towards ensuring eligible prisoners access ART programs promptly and that inter-facility transfers and release procedures facilitate continuity of care. Institutional TB control measures should remain a priority.



Autor: Natasha E. C. G. Davies , Alan S. Karstaedt

Fuente: http://plos.srce.hr/



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