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HIV/AIDS
Cohort profile
Cohort profile: the Right to Care Clinical HIV Cohort, South Africa
  1. Matthew P Fox1,2,3,
  2. Mhairi Maskew3,
  3. Alana T Brennan1,2,3,
  4. Denise Evans3,
  5. Dorina Onoya3,
  6. Given Malete3,
  7. Patrick MacPhail4,5,
  8. Jean Bassett6,
  9. Osman Ebrahim7,
  10. Dikeledi Mabotja8,
  11. Sello Mashamaite4,
  12. Lawrence Long3,
  13. Ian Sanne5
  1. 1 Department of Global Health, Boston University School of Public Health, Boston, Massachusetts, USA
  2. 2 Department of Epidemiology, Boston University, Boston, Massachusetts, USA
  3. 3 Department of Medicine, Faculty of Health Sciences, Health Economics and Epidemiology Research Office, University of the Witwatersrand, Johannesburg, South Africa
  4. 4 Right to Care, Johannesburg, South Africa
  5. 5 Department of Medicine, Clinical HIV Research Unit, University of the Witwatersrand, Johannesburg, South Africa
  6. 6 Witkoppen Health and Welfare Centre, Johannesburg, South Africa
  7. 7 Osman Clinic, Johannesburg, South Africa
  8. 8 Thuthukani Clinic, Johannesburg, South Africa

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.

  • HIV & AIDS
  • INFECTIOUS DISEASES
  • retention

This is an Open Access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/

https://doi.org/10.1136/bmjopen-2016-015620

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    Footnotes

    • Contributors MPF and MM conceptualised the study. MPF and MM wrote the first draft. GM conducted the data analysis. MPF, MM, ATB, DE, DO, GM, PM, JB, OE, DM, SM, LL and IS contributed to interpreting the data and to the writing and revising of the manuscript.

    • Funding This study is made possible by the generous support of the American people through Cooperative Agreement AID 674-A-12-00029 from the US Agency for International Development (USAID).

    • Disclaimer The contents are the responsibility of the authors and do not necessarily reflect the views of USAID or the US Government. The funders had no role in study design, data collection and analysis, decision to publish or preparation of the manuscript.

    • Competing interests None declared.

    • Ethics approval Boston University Institutional Review Board, University of the Witwatersrand Human Research Ethics Committee.

    • Provenance and peer review Not commissioned; externally peer reviewed.

    • Data sharing statement Investigators wishing to work with the data should contact the team at the Health Economics and Epidemiology Research Office and send a concept sheet for the analyses they are interested in performing and the variables that would be required. Anyone wishing to work with the data from the Right to Care Cohort must seek IRB approval from both their own institutions and from the Human Research Ethics Committee (Medical) of the University of the Witwatersrand. After receiving such approvals those wishing to work with the data must sign a data-use agreement. Those wishing to find out more about the Right to Care cohort can visit the website of the Health Economics and Epidemiology Research Office in Johannesburg, South Africa at.

    • Correction notice This paper has been amended since it was published Online First. Owing to a scripting error, some of the publisher names in the references were replaced with 'BMJ Publishing Group'. This only affected the full text version, not the PDF. We have since corrected these errors and the correct publishers have been inserted into the references. Mhairi Maskew was correctly listed as the second author but then listed again at the end of the author list. This has been corrected so he only appears once in the author list.