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The effectiveness and determinants of effectiveness of antiretroviral therapy for adults in the Western Cape Province of South Africa
Antiretroviral therapy (ART) first became available in the public sector in the Western Cape Province in Khayelitsha in 2001. This thesis describes the effectiveness of ART in Khayelitsha and the Province, following adult patients for up to five years on ART, and examining temporal trends over seven...
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| Format: | Thesis |
| Language: | English |
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Department of Public Health and Family Medicine
2023
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| _version_ | 1867613321977397248 |
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| access_status_str | Open Access |
| author | Boulle, Andrew |
| author2 | Myers, Jonny |
| author_browse | Boulle, Andrew Myers, Jonny |
| author_facet | Myers, Jonny Boulle, Andrew |
| author_sort | Boulle, Andrew |
| collection | Thesis |
| description | Antiretroviral therapy (ART) first became available in the public sector in the Western Cape Province in Khayelitsha in 2001. This thesis describes the effectiveness of ART in Khayelitsha and the Province, following adult patients for up to five years on ART, and examining temporal trends over seven years during which time the availability of ART in the Province increased dramatically. Associations are explored with a range of clinical outcomes, and regimen durability and tolerability are described, together with regimen effectiveness when ART is administered to patients co-infected with tuberculosis. The results chapters of the thesis are presented in the form of published or submitted papers. The first paper corrects for under-ascertainment of mortality through linkages with the death registry. After five years on ART, four out of five patients were still alive. Survival did not deteriorate in more recent years despite the large increase in patient numbers. Patients who remained virologically suppressed experienced on average continued CD4 count recovery throughout follow-up to five years. The second paper describes the tolerability of each commonly used first-line antiretroviral drug in two townships in the Western Cape. Treatment-limiting toxicities were frequent and continued throughout follow-up in patients on stavudine (21% by 3 years on ART). Symptomatic hyperlactataemia or lactic acidosis as well as lipodystrophy were strongly associated with women initiating ART with a high initial body mass. The third paper explores the effectiveness of ART when co-administered with tuberculosis treatment, identifying that co-infected patients initiating nevirapinebased ART may be at a higher risk of virological failure, but that concurrent tuberculosis treatment did not otherwise compromise ART outcomes. The fourth paper, based on a household survey, provides an in-depth description of the Khayelitsha population demonstrating comparability with many of the urban settings in which ART is provided in the region. The final paper demonstrates that outcomes have not been compromised by the wider availability of ART in the Western Cape Province. The thesis concludes that the Khayelitsha and Provincial analyses provide considerable reassurance that the anticipated benefits of ART have not to date been eroded by health system weaknesses or contextual challenges. |
| format | Thesis |
| id | oai:open.uct.ac.za:11427/38565 |
| institution | University of Cape Town (South Africa) |
| language | eng |
| last_indexed | 2026-06-10T12:34:17.944Z |
| license_str | Not specified — see source repository |
| provenance_str_mv | Harvested via OAI-PMH from UCTD — University of Cape Town Open Access Repository |
| publishDate | 2023 |
| publishDateRange | 2023 |
| publishDateSort | 2023 |
| publisher | Department of Public Health and Family Medicine |
| publisherStr | Department of Public Health and Family Medicine |
| record_format | dspace |
| source_str | UCTD — University of Cape Town Open Access Repository |
| spelling | oai:open.uct.ac.za:11427/38565 The effectiveness and determinants of effectiveness of antiretroviral therapy for adults in the Western Cape Province of South Africa Boulle, Andrew Myers, Jonny Maartens, Gary Public health and family medicine Antiretroviral therapy (ART) first became available in the public sector in the Western Cape Province in Khayelitsha in 2001. This thesis describes the effectiveness of ART in Khayelitsha and the Province, following adult patients for up to five years on ART, and examining temporal trends over seven years during which time the availability of ART in the Province increased dramatically. Associations are explored with a range of clinical outcomes, and regimen durability and tolerability are described, together with regimen effectiveness when ART is administered to patients co-infected with tuberculosis. The results chapters of the thesis are presented in the form of published or submitted papers. The first paper corrects for under-ascertainment of mortality through linkages with the death registry. After five years on ART, four out of five patients were still alive. Survival did not deteriorate in more recent years despite the large increase in patient numbers. Patients who remained virologically suppressed experienced on average continued CD4 count recovery throughout follow-up to five years. The second paper describes the tolerability of each commonly used first-line antiretroviral drug in two townships in the Western Cape. Treatment-limiting toxicities were frequent and continued throughout follow-up in patients on stavudine (21% by 3 years on ART). Symptomatic hyperlactataemia or lactic acidosis as well as lipodystrophy were strongly associated with women initiating ART with a high initial body mass. The third paper explores the effectiveness of ART when co-administered with tuberculosis treatment, identifying that co-infected patients initiating nevirapinebased ART may be at a higher risk of virological failure, but that concurrent tuberculosis treatment did not otherwise compromise ART outcomes. The fourth paper, based on a household survey, provides an in-depth description of the Khayelitsha population demonstrating comparability with many of the urban settings in which ART is provided in the region. The final paper demonstrates that outcomes have not been compromised by the wider availability of ART in the Western Cape Province. The thesis concludes that the Khayelitsha and Provincial analyses provide considerable reassurance that the anticipated benefits of ART have not to date been eroded by health system weaknesses or contextual challenges. 2023-09-13T07:01:04Z 2023-09-13T07:01:04Z 2009 2023-08-17T13:38:48Z Doctoral Thesis Doctoral PhD http://hdl.handle.net/11427/38565 eng application/pdf Department of Public Health and Family Medicine Faculty of Health Sciences |
| spellingShingle | Public health and family medicine Boulle, Andrew The effectiveness and determinants of effectiveness of antiretroviral therapy for adults in the Western Cape Province of South Africa |
| thesis_degree_str | Doctoral |
| title | The effectiveness and determinants of effectiveness of antiretroviral therapy for adults in the Western Cape Province of South Africa |
| title_full | The effectiveness and determinants of effectiveness of antiretroviral therapy for adults in the Western Cape Province of South Africa |
| title_fullStr | The effectiveness and determinants of effectiveness of antiretroviral therapy for adults in the Western Cape Province of South Africa |
| title_full_unstemmed | The effectiveness and determinants of effectiveness of antiretroviral therapy for adults in the Western Cape Province of South Africa |
| title_short | The effectiveness and determinants of effectiveness of antiretroviral therapy for adults in the Western Cape Province of South Africa |
| title_sort | effectiveness and determinants of effectiveness of antiretroviral therapy for adults in the western cape province of south africa |
| topic | Public health and family medicine |
| url | http://hdl.handle.net/11427/38565 |
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