Non‐Communicable Diseases and Antiretroviral Therapy Outcomes Among Stable ART Patients (RapIT-NCD)

Project Description

For national antiretroviral therapy (ART) programs, one of the most important goals in reducing morbidity and mortality is to achieve the highest possible long-term retention of patients on ART. In South Africa, cohort data have consistently found high attrition among ART patients, with the combined cumulative outcomes of death and loss to follow up averaging 25-40% over the first five years after ART initiation. Like many other middle income countries, South Africa also faces very high rates of non-communicable diseases (NCDs) and NCD risks. Despite this, there are few studies that have looked at interactions between ART and NCDs or considered the effect of NCDs and NCD risk factors on achieving long-term retention on ART.

In this study, which is a supplemental study to the RapIT trial, CGHD and HE2RO are evaluating the role of NCDs and NCD risk factors on long-term retention on ART, with outcomes including mortality, loss to follow up, viral suppression and immunologic improvement, and physical functioning, ability to perform normal daily activities, and economic productivity among patients already on ART. Between April 2014 and April 2015, the study enrolled approximately 300 adult ART patients age 35 or older who had been on treatment at a public sector primary health clinic for at least 12 months at the time of study enrollment. At their enrollment visit, subjects were screened for elevated levels of several NCD risk factors including body mass index; glucose using HbA1c levels; blood pressure and cholesterol; as well as signs of abnormalities in hepatic, renal, and lung function. A medical history was taken and a questionnaire used to gather information about chronic pain, alcohol use, smoking, physical functioning, ability to perform normal daily activities, and economic productivity. Referral for further NCD diagnosis and care was offered as needed. During follow up of up to 24 months, routine electronic medical records will be accessed to obtain ART outcome data such as viral suppression and retention in care, and associations between NCD risks and conditions and ART outcomes evaluated.

Project Details

Principal Investigator Sydney Rosen
Boston University Co-Investigators Matthew Fox
Collaborators
Country(ies) South Africa
Dates of Research 2013-2016
Donor/Funder HIN logo National Institutes of Health (NIH)