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Outcomes of a Remote, Decentralized Health Center-Based HIV/AIDS Antiretroviral Program in Zambia, 2003 to 2007

Médecins Sans Frontières-Holland, Lusaka/Nchelenge,Zambia

Clair Mills, MD, MSc

Médecins Sans Frontières-Holland, Amsterdam, Netherlands

Oliver Yun, MA

Médecins Sans Frontières-USA, New York

Kamalini Lokuge

Médecins Sans Frontières-Holland, Lusaka/Nchelenge, Zambia

Charles Ssonko, MD

Médecins Sans Frontières-Holland, Lusaka/Nchelenge,Zambia

Nashiola Nyirongo

Médecins Sans Frontières-Holland, Lusaka/Nchelenge,Zambia

Velepi Mtonga, MD

Ministry of Health, Lusaka/Nchelenge, Zambia

Henry Zulu

Ministry of Health, Lusaka/Nchelenge, Zambia

David Tu, MD

Médecins Sans Frontières-Holland, Vancouver, Canada

Meggy Verputten

Médecins Sans Frontières-Holland, Amsterdam, Netherlands

Daniel P. O'Brien, MD, FRACP

Médecins Sans Frontières-Holland, Amsterdam, Netherlands,daniel.obrien{at}amsterdam.msf.org

A cross-sectional study of patients living with HIV/ AIDS treated during 2003 to 2007 in decentralized, rural health centers in Zambia was performed to measure virological outcomes after 12 months of antiretroviral therapy and identify factors associated with virological failure. Data from 228 patients who started antiretroviral therapy >12 months prior were analyzed. In all, 93% received stavudine + lamivudine + nevirapine regimens, and median antiretroviral therapy duration was 23.5 months (interquartile range 20-28). Of the 205 patients tested for viral load, 177 (86%) had viral load <1000 copies/mL. Probability of developing virological failure (viral load >1000 copies/mL) was 8.9% at 24 months and 19.6% at 32 months. Predictors for virological failure were <100% adherence, body mass index <18.5 kg/m², and women <40 years old. Of those with virological failure who underwent 3 to 6 months of intensive adherence counseling, 45% obtained virological success. In a remote, resource-limited setting in decentralized health centers, virological and immunological assessments of patients on antiretroviral therapy >12 months showed that positive health outcomes are achievable.

Key Words: antiretroviral therapy • HIV • rural health centers • sub-Saharan Africa • viral load

This version was published on January 1, 2009

Journal of the International Association of Physicians in AIDS Care (JIAPAC), Vol. 8, No. 1, 60-67 (2009)
DOI: 10.1177/1545109709331472


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