Outcomes of on-site antiretroviral therapy provision in a South African correctional facility. (November 2016)

• Record Type: Journal Article
• Authors: Telisinghe, Lilanganee; Hippner, Piotr; Churchyard, Gavin J; Gresak, Gillian; Grant, Alison D; Charalambous, Salome; Fielding, Katherine L
• Is Part Of: International journal of STD & AIDS. Volume 27:Number 13(2016)
• Page Start: 1153
• Page End: 1161
• Publication Date: 2016-11
• Subjects: HIV -- AIDS -- treatment -- prisoners -- correctional facilities -- inmates -- antiretroviral therapy; Sexually transmitted diseases -- Periodicals; AIDS (Disease) -- Periodicals; 616.951
• DOI: 10.1177/0956462415584467
• Languages: English
• ISSNs: 0956-4624

Abstract

We evaluated a novel on-site antiretroviral therapy (ART) programme in a South African correctional facility using routinely collected programme data, from a retrospective cohort of adult inmates starting ART between 03/2007 and 03/2009 followed-up to 09/2009. We report (1) mortality (using survival analysis); (2) retention in the programme (to 09/2009); and (3) virological suppression at six and 12 months (<400 copies/ml) following ART initiation. In total, 404 started ART (median age 33 years; 91.3% men; median baseline CD4 cell count 152 cells/µl [interquartile range 85–225]). Among 299 starting ART for the first time (ART-naïve), 23 deaths occurred during 252 person-years (median follow-up nine months). Mortality rates were 17.2 at 0–6 months (95% confidence interval 10.9–26.9) and 2.8 at >6 months (95% confidence interval 1.1–7.5)/100 person-years; p < 0.001. At 09/2009, 35.6% (144/404) remained in the correctional facility, with 94.4% (136/144) retained in the programme; 38.4% (155/404) were released; and 20.0% (81/404) transferred to another facility. ART-naïve patients in care six and 12 months after ART initiation, 94.7% (124/131) and 92.5% (74/80) were virologically suppressed, respectively. High early mortality warrants the early identification and management of HIV-positive inmates. The high mobility of inmates necessitates systems for facilitating continuity of care. Good virological responses and retention supports decentralising HIV care to correctional facilities.