Long-Term Outcome of an XXXX -Treatment Programme in Rural Africa: Viral Suppression despite Early Mortality.

@entity1 @entity645
Objective. To define the long-term (2-4 years) clinical and virological outcome of an antiretroviral treatment (ART) programme in rural South Africa. Methods. We performed a retrospective observational cohort study, including 735 @entity1 who initiated ART. Biannual monitoring, including @entity645 -RNA testing, was performed. Primary endpoint was @entity1 retention; virological suppression ( @entity645 -RNA <   50 copies/mL) and failure ( @entity645 -RNA >   1000 copies/mL) were secondary endpoints. Moreover, possible predictors of treatment failure were analyzed. Results. 63% of @entity1 (466/735) have a fully suppressed @entity645 -RNA, a median of three years after treatment initiation. Early mortality was high: 14% died within 3 months after treatment start. 16% of @entity1 experienced virological failure, but only 4% was switched to second-line ART. Male gender and a low performance score were associated with treatment failure; immunological failure was a poor predictor of virological failure. Conclusions. An "all or nothing" phenomenon was observed in this rural South African ART programme: high early attrition, but good virological control in those remaining in care. Continued efforts are needed to enrol @entity1 earlier. Furthermore, the observed viro-immunological dissociation emphasises the need to make @entity645 -RNA testing more widely available.
