Setting ART initiation targets in response to changing guidelines : The importance of addressing both steady-state and backlog

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dc.contributor.authorMartin, C
dc.contributor.authorNaidoo, N P
dc.contributor.authorVenter, W D F
dc.contributor.authoret al.
dc.date.accessioned2015-06-10T12:39:35Z
dc.date.available2015-06-10T12:39:35Z
dc.date.issued2014-06
dc.departmentFamily Medicine
dc.descriptionPKen_ZA
dc.description.abstractBackground: Target setting is useful in planning, assessing and improving antiretroviral treatment (ART) programmes. In the past 4 years, the ART initiation environment has been transformed due to the change in eligibility criteria (starting ART at a CD4+ count <350 cells/μl v. <200 cells/μl) and the roll-out of nurse-initiated management of ART. Objective: To describe and illustrate the use of a target-setting model for estimating district-based targets in the era of an expanding ART programme and changing CD4+ count thresholds for ART initiation. Method: Using previously described models and data for annual new HIV infections, we estimated both steady-state need for ART initiation and backlog in a North West Province district, accounting for the shift in eligibility. Comparison of actual v. targeted ART initiations was undertaken. The change in CD4+ count threshold adds a once-off group of newly eligible patients to the pool requiring ART – the backlog. The steady-state remains unchanged as it is determined by the annual rate of new HIV infections in previous years. Results: The steady-state need for the district was 639 initiations/month, and the backlog was ~15 388 patients. After the shift in eligibility in September 2011, the steady-state target was exceeded over several months with some backlog addressed. Of the total backlog for this district, 72% remains to be cleared. Conclusion: South Africa has two pools of patients who need ART: the steady-state of HIV-infected patients entering the programme each year, determined by historical infection rates; and the backlog created by the shift in eligibility. The healthcare system needs to build longterm capacity to meet the steady-state need for ART and additional capacity to address the backlog.en_ZA
dc.identifier.citationMartin, C., Naidoo, N P., Venter, W D F., et al. 2014. Setting ART initiation targets in response to changing guidelines : The importance of addressing both steady-state and backlog. SAMJ;104(6):428-430.en_ZA
dc.identifier.urihttp://hdl.handle.net/10539/17965
dc.language.isoenen_ZA
dc.subjectAntiretroviral Therapy, Highly Activeen_ZA
dc.subjectHIV Infectionsen_ZA
dc.subjectSouth Africaen_ZA
dc.titleSetting ART initiation targets in response to changing guidelines : The importance of addressing both steady-state and backlogen_ZA
dc.typeArticleen_ZA
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