The Keiskamma AIDS treatment programme: evaluation of a community-based antiretroviral programme in a rural setting

Abstract

This paper documents the outcomes of the first 174 patients enrolled in a recently established community-based antiretroviral (ARV) treatment programme. Many people are living with HIV/AIDS and are in need of ARVs. Access to ARVs can pose many logistical difficulties for poor and sick persons, particularly in rural areas. This communitybased treatment programme aimed to overcome these challenges, providing transport and nursing care, as well as actively seeking persons too sick to leave their homes. This led to the inclusion of many persons with advanced HIV in the treatment population. The study used routinely collected CD4 counts, viral loads and patient observation. The results show that the majority of patients responded well to treatment. There was higher mortality among the population with advanced disease, but a considerable proportion responded well. Only 4 patients were lost to follow-up. This study details how community-based ARV programmes can be useful adjuncts to the facility-based system. Effective treatment programmes must address the needs of the communities they serve.