Background: There is strong evidence to show that antiretroviral therapy (ART)
improves the survival and quality of life of people living with HIV/AIDS (PLWHA).
Namibia, one of the countries hardest hit by HIV/AIDS, has embarked on a large
scale public sector roll out of ART. The Catholic Health Services is implementing an
HIV/AIDS treatment program in Nyangana rural district, home to 41,000 people with
an HIV seroprevalence (ANC, 2006) of 12%. Aim: This study aims to analyse the
clinical and immunological responses and survival pattern of HIV/AIDS patients
receiving ART in Nyangana District. Objectives: To establish the ART coverage and
demographic characteristics of eligible PLWHA in Nyangana district, to describe
baseline clinical profile and subsequent clinical response of HIV/AIDS patients
receiving ART and to determine baseline immunological profile and the trend of CD4
count response from baseline to different follow up periods. Study design: This is a
quantitative, cohort analysis study of routine clinical data, reviewing patients’ records
retrospectively. Population and sample: This was a census of all patients that started
ART in the district between August 2004 and April 2006. Data collection process:
Standardised patient files and registers were used to abstract data as per selected
variables into an Excel database. Data analysis: Epi Info and SPSS were used. A
cohort analysis was done using descriptive and analytic statistics to determine basic
characteristics, overall treatment outcome, survival analysis (KM, Cox regression),
paired comparison to determine change in weight and CD4 cell count pre and postART.
Results: ART is currently reaching 46% of PLWHA in need of it in Nyangana
District. At baseline, the mean age was 36 years, mean weight was 48 kg and median
CD4 cell count was 131 cells/µL (IDR: 75-216). Females represented 69% of
patients, were more likely to have higher CD4 count at baseline (p<0.0001) and more
likely to survive compared to males (OR: 2.3). The mean duration on ART was 20.8
and 5.1 months, respectively, for those still alive and those who died. A mortality rate
of 23.5% occurred mainly in the first 3 months of initiation (60%) with TB (37.9%)
and gastroenteritis (18.2%) as leading causes of death. Patients with lower body
weight and poor functional status were less likely to survive (OR: 0.9 and 0.4) and
those who died were twice as likely to have fair to poor self-reported adherence
(p=0.008). Survival at 24 months was 75%.