Public-health and individual approaches to antiretroviral therapy: township South Africa and Switzerland compared

BACKGROUND: The provision of highly active antiretroviral therapy (HAART) in resource-limited settings follows a public health approach, which is characterised by a limited number of regimens and the standardisation of clinical and laboratory monitoring. In industrialized countries doctors prescribe from the full range of available antiretroviral drugs, supported by resistance testing and frequent laboratory monitoring. We compared virologic response, changes to first-line regimens, and mortality in HIV-infected patients starting HAART in South Africa and Switzerland. METHODS AND FINDINGS: We analysed data from the Swiss HIV Cohort Study and two HAART programmes in townships of Cape Town, South Africa. We included treatment-naïve patients aged 16 y or older who had started treatment with at least three drugs since 2001, and excluded intravenous drug users. Data from a total of 2,348 patients from South Africa and 1,016 patients from the Swiss HIV Cohort Study were analysed. Median baseline CD4+ T cell counts were 80 cells/mul in South Africa and 204 cells/mul in Switzerland. In South Africa, patients started with one of four first-line regimens, which was subsequently changed in 514 patients (22%). In Switzerland, 36 first-line regimens were used initially, and these were changed in 539 patients (53%). In most patients HIV-1 RNA was suppressed to 500 copies/ml or less within one year: 96% (95% confidence interval [CI] 95%-97%) in South Africa and 96% (94%-97%) in Switzerland, and 26% (22%-29%) and 27% (24%-31%), respectively, developed viral rebound within two years. Mortality was higher in South Africa than in Switzerland during the first months of HAART: adjusted hazard ratios were 5.90 (95% CI 1.81-19.2) during months 1-3 and 1.77 (0.90-3.50) during months 4-24. CONCLUSIONS: Compared to the highly individualised approach in Switzerland, programmatic HAART in South Africa resulted in similar virologic outcomes, with relatively few changes to initial regimens. Further innovation and resources are required in South Africa to both achieve more timely access to HAART and improve the prognosis of patients who start HAART with advanced disease.

Northeastern United States, 1799 : showing township grants and land purchases in New York (Raster Image)

This layer is a georeferenced raster image of the historic paper map entitled: Map of the middle states of North America : shewing the position of the Geneseo country comprehending the counties of Ontario & Steuben as laid off in townships of six miles squar[e] each, Maverick, sculpt. It was printed by T. & J. Swords for Charles Williamson's Description of the settlement of the Genesee country, in the state of New-York, 1799. Scale [ca. 1:2,250,000]. Partial cadastral map showing large land purchases and township grants in New York State. Covers New York, Pennsylvania, Vermont, Massachusetts, Connecticut, New Jersey, Washington, D.C. and portions of Maryland, Delaware, and West Virginia. The image inside the map neatline is georeferenced to the surface of the earth and fit to the Universal Transverse Mercator (UTM) Zone 18N NAD83 projection. All map collar and inset information is also available as part of the raster image, including any inset maps, profiles, statistical tables, directories, text, illustrations, index maps, legends, or other information associated with the principal map. This map shows features such as roads, drainage, major cities and towns, land purchases, township grants, state boundaries, and more. Includes key to "principal villages in Ontario & Steuben counties." This layer is part of a selection of digitally scanned and georeferenced historic maps from The Harvard Map Collection as part of the Imaging the Urban Environment project. Maps selected for this project represent major urban areas and cities of the world, at various time periods. These maps typically portray both natural and manmade features at a large scale. The selection represents a range of regions, originators, ground condition dates, scales, and purposes.

Union Township Drainage District : environmental impact statement.

F available only in microfiche.

Map of Salem Township. Town 1 south. Range 7 east [plat]

Publication information: Chicago, Ill. : Everts & Stewart, 1874.

Salem Township (Mich.) residences, ca. 1874

Left to right: Res. of Daniel T. Birch, Sec. 31, Salem Tp. Mich.; Res. of J.L. Bennett, Sec. 15, Salem Tp. Mich.; Res. of Calvin Wheeler, Sec. 27, Salem Tp. Mich.; Res. of G.N.B. Renwick, Sec 27, Salem Tp. Mich.; Res. of Eli O. Smith, Sec 14, Salem Tp. Mich.; Res. of T.B. Gorton, Sec 3. Salem Tp. Mich. Publication information: Chicago, Ill. : Everts & Stewart, 1874.

Northfield and Salem Township (Mich.) residences, ca. 1874

Left to right: Res. of Geo. Sutton, Sec 34, Northfield Tp. Mich.; Res. of Geo. Renwick, Sec. 26, Northfield Tp., Mich.; Res. of A.C. Northrop, Sec. 10, Salem Tp. Mich.; Res. of Nelson Brundage, Sec. 35, Northfield Tp. Mich. (na5543); Res. of Dr. N.S. Halleck, Sec. 5, Northfield, Mich. Publication information: Chicago, Ill. : Everts & Stewart, 1874.

Map of Northfield Township. Town No.1 south. Range No.6 east [plat]

Publication information: Chicago, Ill. : Everts & Stewart, 1874

Map of Dexter Township. Town No. 1 south. Range no. 4 east [plat]

Publication information: Chicago, Ill. : Everts & Stewart, 1874.