Introduction

1. Primary Healthcare Facilities Deliver More Effective Antiretroviral Therapy: An Evaluation in Four Provinces in South AfricaGeoffrey Fatti, Ashraf Grimwood and Peter Bock Kheth’Impilo, Cape Town, South Africa Introduction Conflicting results of ART effectiveness between primary healthcare (PHC) facilities and hospitals in low-income settings have been reported. We compared adult ART outcomes between facility levels in four South African provinces. Methods Retrospective cohort study using routine electronic data of ART-naïve adults from 47 PHC facilities, 9 district hospitals and 3 regional hospitals. Represents over 7% of South African public-sector ART patients enrolled between 2004–2007. Outcomes: Mortality, LTFU and virological suppression compared between levels of care. Results 29,203 adults; 68.1% women included Baseline CD4 cell counts similar between facility levels (median 114 (IQR: 57-166) ; patients enrolling at PHC facilities had more advanced clinical stage disease (79% ≥ WHO stage III, P < 0.001).

2. LTFU RIC P < 0.0001 P < 0.0001 Mortality Transfer-out P < 0.0001 P < 0.0001

3. Adjusted regression analyses: (comparing to PHC facilities) • LTFU independently increased at regional hospitals; aHR 2.19 (CI: 1.94–2.47) • Mortality independently increased at district hospitals; aHR 1.60 (CI: 1.30–1.99) • VS independently reduced at district and regional hospitals; aOR 0.71 (CI: 0.55−0.90) and 0.66 (CI: 0.58–0.75) respectively (any time point). • Conclusions: Patients treated at PHC facilities had superior longitudinal outcomes. Wide-scale ART delivery at the primary level of care may be a solution to meeting the large treatment need in South Africa. • Prospective research: determine degree to which outcome differences are attributable to facility characteristics, environmental factors or patient clinical co-morbidity at hospitals. P-values: <0.001 <0.001 0.083 0.009 0.063 0.035