PMID- 23922711
OWN - NLM
STAT- MEDLINE
DCOM- 20140429
LR  - 20231106
IS  - 1932-6203 (Electronic)
IS  - 1932-6203 (Linking)
VI  - 8
IP  - 7
DP  - 2013
TI  - Outcomes and impact of HIV prevention, ART and TB programs in Swaziland--early 
      evidence from public health triangulation.
PG  - e69437
LID - 10.1371/journal.pone.0069437 [doi]
LID - e69437
AB  - INTRODUCTION: Swaziland's severe HIV epidemic inspired an early national response 
      since the late 1980s, and regular reporting of program outcomes since the onset 
      of a national antiretroviral treatment (ART) program in 2004. We assessed 
      effectiveness outcomes and mortality trends in relation to ART, HIV testing and 
      counseling (HTC), tuberculosis (TB) and prevention of mother to child 
      transmission (PMTCT). METHODS: Data triangulated include intervention coverage 
      and outcomes according to program registries (2001-2010), hospital admissions and 
      deaths disaggregated by age and sex (2001-2010) and population mortality 
      estimates from the 1997 and 2007 censuses and the 2007 demographic and health 
      survey. RESULTS: By 2010, ART reached 70% of the estimated number of people 
      living with HIV/AIDS with CD4<350/mm(3), with progressively improving patient 
      retention and survival. As of 2010, 88% of health facilities providing antenatal 
      care offered comprehensive PMTCT services. The HTC program recorded a halving in 
      the proportion of adults tested who were HIV-infected; similarly HIV infection 
      rates among HIV-exposed babies halved from 2007 to 2010. Case fatality rates 
      among hospital patients diagnosed with HIV/AIDS started to decrease from 2005-6 
      in adults and especially in children, contrasting with stable case fatality for 
      other causes including TB. All-cause child in-patient case fatality rates started 
      to decrease from 2005-6. TB case notifications as well as rates of HIV/TB 
      co-infection among notified TB patients continued a steady increase through 2010, 
      while coverage of HIV testing and CPT for co-infected patients increased to above 
      80%. CONCLUSION: Against a background of high, but stable HIV prevalence and 
      decreasing HIV incidence, we documented early evidence of a mortality decline 
      associated with the expanded national HIV response since 2004. Attribution of 
      impact to specific interventions (versus natural epidemic dynamics) will require 
      additional data from future household surveys, and improved routine (program, 
      surveillance, and hospital) data at district level.
FAU - van Schalkwyk, Cari
AU  - van Schalkwyk C
AD  - The South African Department of Science and Technology / National Research 
      Foundation Centre of Excellence in Epidemiological Modelling and Analysis, 
      University of Stellenbosch, Cape Town, South Africa. carivs@sun.ac.za
FAU - Mndzebele, Sibongile
AU  - Mndzebele S
FAU - Hlophe, Thabo
AU  - Hlophe T
FAU - Garcia Calleja, Jesus Maria
AU  - Garcia Calleja JM
FAU - Korenromp, Eline L
AU  - Korenromp EL
FAU - Stoneburner, Rand
AU  - Stoneburner R
FAU - Pervilhac, Cyril
AU  - Pervilhac C
LA  - eng
PT  - Journal Article
PT  - Research Support, Non-U.S. Gov't
DEP - 20130726
PL  - United States
TA  - PLoS One
JT  - PloS one
JID - 101285081
SB  - IM
MH  - Adolescent
MH  - Adult
MH  - Antiretroviral Therapy, Highly Active/*statistics & numerical data
MH  - Cause of Death
MH  - Comorbidity
MH  - Counseling
MH  - Eswatini/epidemiology
MH  - Female
MH  - HIV Infections/complications/*drug therapy/epidemiology/*prevention & control
MH  - Hospitalization/statistics & numerical data
MH  - Humans
MH  - Incidence
MH  - Infectious Disease Transmission, Vertical/prevention & control
MH  - Inpatients
MH  - Male
MH  - Middle Aged
MH  - National Health Programs/*statistics & numerical data
MH  - Prevalence
MH  - Public Health/*statistics & numerical data
MH  - Survival Analysis
MH  - Treatment Outcome
MH  - Tuberculosis/*complications/epidemiology/*prevention & control
MH  - Young Adult
PMC - PMC3724860
COIS- Competing Interests: The authors have declared that no competing interests exist.
EDAT- 2013/08/08 06:00
MHDA- 2014/04/30 06:00
PMCR- 2013/07/26
CRDT- 2013/08/08 06:00
PHST- 2013/04/18 00:00 [received]
PHST- 2013/06/08 00:00 [accepted]
PHST- 2013/08/08 06:00 [entrez]
PHST- 2013/08/08 06:00 [pubmed]
PHST- 2014/04/30 06:00 [medline]
PHST- 2013/07/26 00:00 [pmc-release]
AID - PONE-D-13-16282 [pii]
AID - 10.1371/journal.pone.0069437 [doi]
PST - epublish
SO  - PLoS One. 2013 Jul 26;8(7):e69437. doi: 10.1371/journal.pone.0069437. Print 2013.