Measuring quality of life, demographic characteristics and ART adherence of patients accessing antiretroviral therapy in the urban and rural settings in KwaZulu-Natal, South Africa.

Overview

The Doris Duke Charitable Foundation's ORACTA Programme supports studies that contribute towards improving the care and treatment of AIDS patients in resource-limited settings, informing anti-retroviral therapy (ART) programme policy and practice, and enhancing the outcomes of the roll-out and scale-up of ART in Africa.

HEARD is working with the Elizabeth Glaser Paediatric AIDS Foundation, the University of KwaZulu-Natal, and the Enhancing Care Initiative - at McCord Hospital and St Mary's Hospital in Durban, and at Mseleni Hospital in rural KwaZulu-Natal, to:

• Establish the cost-effectiveness of different models of anti-retroviral treatment programmes across clinical sites in southern Africa in urban and rural settings.
• Measure quality of life, demographic characteristics and ART adherence of patients accessing anti-retroviral therapy in urban and rural settings in KwaZulu-Natal, South Africa.

The significance of this research lies in showing what factors generate treatment costs across the sites and determine cost-effectiveness of treatment programmes at different sites. The findings will form the basis of recommendations for resource allocation for ART programmes in various settings.

The broader agenda is to support the South African government target of ensuring universal access to prevention, treatment, care and support by 2011.

Research Questions

• Is there a statistically significant difference in resource utilisation rates of HIV care resources (i.e. outpatient clinic visitations, inpatient days, diagnostic testing), due to treatment of opportunistic infections and serious adverse events, and cost of ART delivery in three different models of care in rural, urban and peri-urban settings?
• Is there a positive incremental cost-effective ratio (i.e. a financial savings per life years saved) across the models of care delivery at each site?
• Is there a statistically significant difference in clinical outcomes (i.e. CD4 count levels, viral loads, time to death, incidence of opportunistic infection in specified CD4 count levels etc) across the sites?
• What is the demographic profile of patients accessing ART at different sites and what does it cost them to access care?
• What is the adherence and health related quality of life at the three sites? And what is the relationship between adherence and health related quality of life?

Strategic Questions

PROGRAMMES: 1) "Systemic Interpretations of the Pandemic and Creating Sustainable Response Systems"

THREE CORE QUESTIONS (2006-2010): What constitutes effective responses to the pandemic?

Project Impact

• Will show what the drivers of costs are across the sites and provide the cost of delivering ART in different setting (very useful for budgeting).
• Will show clinical effectiveness of ART at three sites under different models of treatment.
• Will show the demographic profile of patients accessing ART and the what it costs them to access care.
• Show the patients’ health related quality of life at three sites.
• Will show which adherence programme is most effective.
• Show which ART programme is most cost effective.

Brief Description

The Doris Duke Charitable Foundation’s ORACTA Programme supports studies that seek to contribute towards improving the care and treatment of AIDS patients in resource-limited settings, informing anti-retroviral therapy (ART) programme policy and practice, and enhancing the outcomes of the roll-out and scale-up of ART in Africa.

HEARD is working with its partners – the Elizabeth Glaser Paediatric AIDS Foundation, the University of KwaZulu-Natal, and the Enhancing Care Initiative - at McCord Hospital and St Mary’s Hospital in Durban, and at Mseleni Hospital in rural KwaZulu-Natal, to:

• Assess the immunological, virological and clinical outcomes of ART under different models of care,
• Estimate the financial and economic costs of providing a comprehensive model of ART at each site,
• Identify the incremental costs, and cost-effectiveness of differences within models of ART.
• Measure quality of life, demographic characteristics and ART adherence of patients accessing anti-retroviral therapy in urban

The significance of this research lies in showing what factors generate treatment costs across the sites and determining cost-effectiveness of treatment programmes at different sites. The findings will form the basis of recommendations for resource allocation for ART programmes in various settings.

The broader agenda is to support the South African government target of ensuring universal access to prevention, treatment, care and support by 2011.

Collaborators

• Dr Janet Giddy HIV Programmes Co-ordinator McCord Hospital, Durban, South Africa
• Lee Sewnarain Research Project Manager ECI KZN PLUS 3rd Floor Doris Duke Medical Research Institute Nelson R Mandela School of Medicine 719 Umbilo Road Durban
• Richard Marlink, MD Professor of Public Health Harvard School of Public Health Scientific Director - Care and Treatment Elizabeth Glaser Pediatric AIDS Foundation 651 Huntington Avenue Boston, MA 02115
• Dr DP Ross MBBCh MBA (BSN) Chief Executive Officer St Mary's Catholic Mission Hospital Trust
• Dr Helga Holst Superintendent McCord Hospital
• Elizabeth Rulon Administrative and Editorial Assistant The Elizabeth Glaser Pediatric AIDS Foundation 2950 31st Street, Suite 125 Santa Monica, CA 90405
• Victor Fredland Superintendent Mseleni Hospital
• Marionette Holmes
• Mrs Tonya Esterhuizen Biostatistician DVC Health Sciences Desmond Clarence Howard College

Key Phases