Evaluation of treatment progression amongst patients initiated on antiretroviral therapy at the university of Limpopo, South Africa

Abstract

Human Immunodeficiency Virus (HIV) has affected all parts of the world, and as of 2019, more than 76 million people have been infected by HIV. South Africa has the largest population of people living with human immunodeficiency virus (HIV) in the world and the highest infected group were aged 24 to 49, and females had the highest percentage in viral load suppression for all age groups. HIV infection leads to advanced loss of CD4 T cells and the roll out of antiretroviral therapy (ART) has bring about in significant cutbacks in HIV-associated complications by recovering the CD4+ T cell count. Some patients may not be successful in attaining this result, and some may accomplish it only after a number years of treatment. The disease progression and the health conditions amongst People Living with HIV-AIDS (PLWA) has improved substantially in the past two decades. The purpose of this study was to evaluate the disease progression of the patients initiated on ART from 2017 to 2019 at the University of Limpopo Health Centre, in Limpopo province. Methodology: A descriptive retrospective investigation was carried out which followed a quantitative approach in which secondary data from medical files of 259 patients initiated on ART at University of Limpopo Health Centre was used. where outcomes of ART initiation assessed and evaluated in association with characteristics of patients. Data analysis was done using the STATA statistical software version 12 for Windows (STATA Corporation, College Station, Texas). Frequency tables were used to make comparisons between groups for continuous and categorical variables using student t-test, and chi-square test. P-value less than 0.05 at 95% confidence level were regarded as significant. Results: The research finding revealed 80.0% of the study participants were females and the mean age group of participants diagnosed HIV positive was 28.28 years with standard deviation of ±7.5. The mean of the CD4 count cells at baseline for females was 411.4 cells/μL while for males was 341.2 cells/μL (p=0.212). The mean CD4 count cells at last ART visit for females was 613.7 cells/μL while for males was 452.9 cells/μL (p<0.001). There has been significant increase of the CD4 cell count from the baseline to the last ART visit as it is noted in the increase in proportion of patients with CD4 cell count of more than 500 in all the years. The proportion of patients with baseline CD4 cell count of 200 to 350 (moderate immunodepression) were high in 2019 and 2017 at 40.6% and 40.3% respectively. Majority of the patients were transferred out to other facilities at 79.4% as most patients are students and only 2.3% mortality rate has been reported for the study period. Majority of the patients initiated on ART at University of Limpopo were in WHO stage 2 at 45.5% followed by those in stage 3 and stage 1 at 22.2% and 21.8% respectively. Patients who were 24 years or older were 1.1 times more likely to have improved CD4 cell count at the last date of ART visit as compared to younger patients but not statistically significant while males were 3.5 times more likely to have improved CD4 cell count at the last date of ART visit as compared to females which was statistically significant. Patients who were initiated on ART at WHO stage 4 were 6.67 more likely to have improved CD4 cell count at the last date of ART visit as compared to those who were initiated on ART at WHO stage 1. Conclusion: The treatment progression in the study setting was found to be convincing and acceptable which is similar to the findings reported in other studies in many other countries. The significance of CD4 cell counts monitoring for HIV patients cannot be overemphasised. This study recommends a strengthened testing and treatment programme targeted males amongst the university community, enhance provider provider relationship when patients are transferred out to other health facilities, enhance the collection of baseline and progressive data on both the CD4 cell count and viral load.