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. 2017 Jun 10;7(6):e015620.
doi: 10.1136/bmjopen-2016-015620.

Cohort profile: the Right to Care Clinical HIV Cohort, South Africa

Matthew P Fox  1   2   3 , Mhairi Maskew  3 , Alana T Brennan  1   3   2 , Denise Evans  3 , Dorina Onoya  3 , Given Malete  3 , Patrick MacPhail  4   5 , Jean Bassett  6 , Osman Ebrahim  7 , Dikeledi Mabotja  8 , Sello Mashamaite  4 , Lawrence Long  3 , Ian Sanne  5
Affiliations

Cohort profile: the Right to Care Clinical HIV Cohort, South Africa

Matthew P Fox et al. BMJ Open. .

Abstract

Purpose: The research objectives of the Right to Care Clinical HIV Cohort analyses are to: (1) monitor treatment outcomes (including death, loss to follow-up, viral suppression and CD4 count gain among others) for patients on antiretroviral therapy (ART); (2) evaluate the impact of changes in the national treatment guidelines around when to initiate ART on HIV treatment outcomes; (3) evaluate the impact of changes in the national treatment guidelines around what ART regimens to initiate on drug switches; (4) evaluate the cost and cost-effectiveness of HIV treatment delivery models; (5) evaluate the need for and outcomes on second-line and third-line ART; (6) evaluate the impact of comorbidity with non-communicable diseases on HIV treatment outcomes and (7) evaluate the impact of the switch to initiating all patients onto ART regardless of CD4 count.

Participants: The Right to Care Clinical HIV Cohort is an open cohort of data from 10 clinics in two provinces within South Africa. All clinics include data from 2004 onwards. The cohort currently has data on over 115 000 patients initiated on HIV treatment and patients are followed up every 3-6 months for clinical and laboratory monitoring.

Findings to date: Cohort data includes information on demographics, clinical visit, laboratory data, medication history and clinical diagnoses. The data have been used to identify rates and predictors of first-line failure, to identify predictors of mortality for patients on second-line (eg, low CD4 counts) and to show that adolescents and young adults are at increased risk of unsuppressed viral loads compared with adults.

Future plans: Future analyses will inform national models of HIV care and treatment to improve HIV care policy in South Africa.

Keywords: HIV & AIDS; INFECTIOUS DISEASES; retention.

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Conflict of interest statement

Competing interests: None declared.

Figures

Figure 1
Figure 1
Location of clinics in Right to Care Clinical Cohort.
Figure 2
Figure 2
Distribution of first-line antiretroviral therapy regimen component drugs by calendar year. 3TC, lamivudine; AZT, zidovudine; d4T, stavudine; EFV, efavirenz; FTC, emtricitabine; NRTI, nucleoside reverse transcriptase inhibitor; NVP, nevirapine; TDF, tenofovir.
Figure 3
Figure 3
Numbers on antiretroviral therapy and viral load suppression over time in the Right to Care HIV Cohort. This analysis was cross-sectional, and missing viral loads are not included.
See this image and copyright information in PMC

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