Differences in access and patient outcomes across antiretroviral treatment clinics in the Free State province: a prospective cohort study

Objective. To assess differences in access to antiretroviral treatment (ART) and patient outcomes across public sector treatment facilities in the Free State province, South Africa. Design. Prospective cohort study with retrospective database linkage. We analysed data on patients enrolled in the treatment programme across 36 facilities between May 2004 and December 2007, and assessed percentage initiating ART and percentage dead at 1 year after enrolment. Multivariable logistic regression was used to estimate associations of facility-level and patient-level characteristics with both mortality and treatment status. Results. Of 44 866 patients enrolled, 15 219 initiated treatment within 1 year; 8 778 died within 1 year, 7 286 before accessing ART. Outcomes at 1 year varied greatly across facilities and more variability was explained by facility-level factors than by patient-level factors. The odds of starting treatment within 1 year improved over calendar time. Patients enrolled in facilities with treatment initiation available on site had higher odds of starting treatment and lower odds of death at 1 year compared with those enrolled in facilities that did not offer treatment initiation. Patients were less likely to start treatment if they were male, severely immunosuppressed (CD4 count ≤50 cells/μl), or underweight (<50 kg). Men were also more likely to die in the first year after enrolment. Conclusions. Although increasing numbers of patients started ART between 2004 and 2007, many patients died before accessing ART. Patient outcomes could be improved by decentralisation of treatment services, fast-tracking the most immunodeficient patients and improving access, especially for men.

Outcomes in patients waiting for antiretroviral treatment in the Free State Province, South Africa: prospective linkage study

Objective: In South Africa, many HIV-infected patients experience delays in accessing antiretroviral therapy (ART). We examined pretreatment mortality and access to treatment in patients waiting for ART. Design: Cohort of HIV-infected patients assessed for ART eligibility at 36 facilities participating in the Comprehensive HIV and AIDS Management (CHAM) program in the Free State Province. Methods: Proportion of patients initiating ART, pre-ART mortality and risk factors associated with these outcomes were estimated using competing risks survival analysis. Results: Forty-four thousand, eight hundred and forty-four patients enrolled in CHAM between May 2004 and December 2007, of whom 22 083 (49.2%) were eligible for ART; pre-ART mortality was 53.2 per 100 person-years [95% confidence interval (CI) 51.8–54.7]. Median CD4 cell count at eligibility increased from 87 cells/ml in 2004 to 101 cells/ml in 2007. Two years after eligibility an estimated 67.7% (67.1–68.4%) of patients had started ART, and 26.2% (25.6–26.9%) died before starting ART. Among patients with CD4 cell counts below 25 cells/ml at eligibility, 48% died before ART and 51% initiated ART. Men were less likely to start treatment and more likely to die than women. Patients in rural clinics or clinics with low staffing levels had lower rates of starting treatment and higher mortality compared with patients in urban/peri-urban clinics, or better staffed clinics. Conclusions: Mortality is high in eligible patients waiting for ART in the Free State Province. The most immunocompromised patients had the lowest probability of starting ART and the highest risk of pre-ART death. Prioritization of these patients should reduce waiting times and pre-ART mortality.

Reconstructing Iron Age Community Dynamics in Eskisehir Province, Central Turkey

Current understanding of the Iron Age polity of Phrygia in Central Anatolia is primarily based on excavations and survey in the region of the Phrygian capital of Gordion. In order to expand our knowledge of the Phrygian polity, we assess the scale and nature of Iron Age communities in the western (EskiAYehir) region of Phrygia. We address the challenge of interpreting ceramics derived from large-scale archaeological survey by utilizing Neutron Activation Analysis (NAA) of ceramics from 12 sites across the region collected by the EskiAYehir archaeological survey project as well as an excavated assemblage from Aar Hoyuk. While the uniformity in ceramic technology and styles suggest the region is part of the larger Phrygian community, NAA results reveal that (a) ceramic production was regionally highly localized with limited evidence of standardization during the Iron Age and (b) based on evidence of community interaction it is possible to establish a partial chronological sequence of development. These results have implications not only for understanding the internal dynamics within the Phrygian core but also for developing a methodology for comparing ancient polities using commensurate units of interacting communities. The present study is part of the larger Anatolian Iron Age Ceramics project (http://www.une.edu.au/a-ia).

La Sojización: The Soyization" of the Argentine Countryside in the Province of Santa Fe"

In the present era of transnational capitalism, some scholars contend that capital accumulation is achieved primarily through dispossession. This paper seeks to analyze the effects of this dispossession upon small agricultural producers in the developing world. By employing the example of soy producers in Argentina, it should become abundantly clear that the issues confronting these farmers are not simply domestic questions but rather indicative of larger structural issues embedded in the global capitalist system.

Detrital Zircon Evidence for Mixing of Mazatzal Province Age Detritus With Yavapai Age (ca. 1700-1740 Ma) and Older Detritus in the ca. 1650 Ma Mazatzal Province of Central New Mexico, USA

Preliminary detrital zircon age distributions from Mazatzal crustal province quartzite and schist exposed in the Manzano Mountains and Pedernal Hills of central New Mexico are consistent with a mixture of detritus from Mazatzal age (ca. 1650 Ma), Yavapai age (ca. 1720 Ma.), and older sources. A quartzite sample from the Blue Springs Formation in the Manzano Mountains yielding 67 concordant grain analyses shows two dominant age peaks of 1737 Ma and 1791 Ma with a minimum peak age of 1652 Ma. Quartzite and micaceous quartzite samples from near Pedernal Peak give unimodal peak ages of ca. 1695 Ma and 1738 Ma with minimum detrital zircon ages of ca. 1625 Ma and 1680 Ma, respectively. A schist sample from the southern exposures of the Pedernal Hills area gives a unimodal peak age of 1680 Ma with a minimum age of ca. 1635 Ma. Minor amounts of older detritus (>1800 Ma) possibly reflect Trans-Hudson, Wyoming, Mojave Province, and older Archean sources and aid in locating potential source terrains for these detrital zircon. The Blue Springs Formation metarhyolite from near the top of the Proterozoic section in the Manzano Mountains yields 71 concordant grains that show a preliminary U-Pb zircon crystallization age of 1621 ¿ 5 Ma, which provides a minimum age constraint for deposition in the Manzano Mountains. Normalized probability plots from this study are similar to previously reported age distributions in the Burro and San Andres Mountains in southern New Mexico and suggest that Yavapai Province age detritus was deposited and intermingled with Mazatzal Province age detritus across much of the Mazatzal crustal province in New Mexico. This data shows that the tectonic evolution of southwestern Laurentia is associated with multiple orogenic events. Regional metamorphism and deformation in the area must postdate the Mazatzal Orogeny and ca. 1610 Ma ¿ 1620 Ma rhyolite crystallization and is attributed to the Mesoproterozoic ca. 1400 ¿ 1480 Ma Picuris Orogeny.

Farmer land allocation for maize, groundnut and cotton production in Chipata District, Eastern Province, Zambia

Small-scale farmers in the Chipata District of Zambia rely on their farm fields to grow maize and groundnuts for food security. Cotton production and surplus food security crops are used to generate income to provide for their families. With increasing population pressure, available land has decreased and farmers struggle to provide the necessary food requirements and income to meet their family’s needs. The purpose of the study was to determine how a farmer can best allocate his land to produce maize, groundnuts and cotton when constrained by labor and capital resources to generate the highest potential for food security and financial gains. Data from the 2008-2009 growing season was compiled and analyzed using a linear programming model. The study determined that farmers make the most profit by allocating all additional land and resources to cotton after meeting their minimum food security requirements. The study suggests growing cotton is a beneficial practice for small-scale subsistence farmers to generate income when restricted by limited resources.