Treatment outcomes of patients in the National Access to Antiretroviral Program for people living with HIV/AIDS, the Extension Phase (NAPHA Extension)

Abstract

National Access to Antiretroviral Program for people living with HIV/AIDS was established in 2004 in order to increase access of patients to antiretroviral drugs; and extension of the program or NAPHA Extension was implemented in 2006. Its target group was the patients who were uninsured and with limited rights. This study aimed to evaluate treatment outcomes of the patients. It was conducted as a descriptive study using secondary data of the NAPHA Extension program’s database from October 2006 to September 2015. Patients aged <15 years or pregnant women or patients enrolled in the program for PMTCT were excluded from this study. It was found that cumulative number of patients registered in the program was 7,026. Of these, 52.4% were female and 47.6% were male. The mean age was 35 years (SD = 8.4). Most of them were migrants (61.7%). Altogether 70.3% of ARV naïve patients had CD4 level before starting antiretroviral treatment (ART) <200 cells/mm3. Viral load (VL) testing coverage to assess treatment outcome at the first year after ART initiation increased from 3.9% of patients in 2006 to 30.2% in 2014. Proportion of patients with VL suppression (VL <50 copies/ml) increased from 75.0% in 2006 to 84.3% in 2014. Death rate was 4.0% in 2015. Loss to follow-up >90 days after the last appointment date rose from 5.3% in 2006 to 50.5% in 2015. It can be concluded that effectiveness in the first year after ART had increased. However, treatment delay was observed. Furthermore, loss to follow-up rate had increased and VL testing coverage rates were still low. Promotion of early HIV testing and prompted ART were recommended. In addition, quality improvement of services to increase VL testing coverage, counseling and closed monitoring of patients to prevent drop-outs should be conducted.