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.

Transvaal & Orange Free State Regions, South Africa, ca. 1899 (Raster Image)

This layer is a georeferenced raster image of the historic paper map entitled: Bacon's large-print map of the Transvaal and Orange Free State. It was published by G.W. Bacon & Co. ca. 1899. Scale [ca. 1:1,900,000]. Covers also Swaziland, Lesotho, and portions of Botswana, Zimbabwe, and Mozambique.The image inside the map neatline is georeferenced to the surface of the earth and fit to the Africa Sinusoidal projected coordinate system. 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 drainage, cities and other human settlements, territorial and administrative boundaries, roads, railroads, shoreline features, and more. Relief shown by shading and spot heights. Includes also insets: "Map showing the routes from England and India to South Africa", "Environs of Cape Town", "Lorenço Marquez [and vicinity]", 'South Africa" and "Durban and Port Natal".This layer is part of a selection of digitally scanned and georeferenced historic maps from the Harvard Map Collection. These maps typically portray both natural and manmade features. The selection represents a range of originators, ground condition dates, scales, and map purposes.

Free State Region, South Africa, 1899 (Raster Image)

This layer is a georeferenced raster image of the historic paper map entitled: Stanford's new map of the Orange Free State, the southern part of the South African Republic, the northern frontier of Cape Colony, Natal, Basutoland and Delagoa Bay. It was published by E. Stanford in 1899. Scale 1:1,000,000 The image inside the map neatline is georeferenced to the surface of the earth and fit to the Africa Lambert Conformal Conic projected coordinate system. 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 drainage, cities and other human settlements, roads, railroads and stations, administrative and territorial boundaries, shoreline features, and more. Relief shown by shading and spot heights.This layer is part of a selection of digitally scanned and georeferenced historic maps from the Harvard Map Collection. These maps typically portray both natural and manmade features. The selection represents a range of originators, ground condition dates, scales, and map purposes.

The Congo and the founding of its free state : a story of work and exploration /

Mode of access: Internet.

South Africa (the Cape Colony, Natal, Orange Free State, South African Republic, Rhodesia and all other territories south of the Zambesi)

Mode of access: Internet.

The old free state : a contribution to the history of Lunenburg County and southside Virginia /

Mode of access: Internet.

The Congo and the founding of its free state : a story of work and exploration. With over one hundred full-page and smaller illustrations, two large maps, and several smaller ones.

Mode of access: Internet.

The Congo and the founding of its free state;

Mode of access: Internet.

The Uganda protectorate; an attempt to give some description of the physical geography, botany, zoology, anthropology, languages and history of the territories under British protection in East Central Africa, between the Congo Free State and the Rift Valley and between the first degree of south latitude and the fifth degree of north latitude,

Appendix to chapter XIII "Anthropology," and to chapter XIV "Pygmies and forest negroes," by Dr. F. Shrubsall.

The Congo; a report of the Commission of enquiry appointed by the Congo Free State government;

Introductory.--The land régime and the freedom of trade.--Taxation.--Military expeditions.--The concessions.--Depopulation.--The abandoned infants.--Recruiting of soldiers and workmen.--Justice.--Institution of a committee.

A free farmer in a free state: a study of rural life and industry and agricultural politics in an agricultural country,

Plates, except first, printed on both sides.

The 1899 Orange Free State football team tour of Europe:'race', imperial loyalty and sporting contest

In September 1899 an association football team from Bloemfontein in the Orange Free State, South Africa, arrived in the United Kingdom. The team comprised 16 black South Africans who played under the auspices of the whites-only Orange Free State Football Association and was the first ever South African football team to tour abroad. In a four-month tour the team played 49 matches against opposition in England, France, Ireland, Scotland and Wales. A small but growing body of work focuses on black sport and football in particular and the 1899 tour is referred to in passing in a few publications, although none have attempted to uncover details of the team or the matches that were played in Europe. This article attempts to do this by drawing on a range of sources in South Africa and the United Kingdom and argues the case for the significance of this team for football history in general and South African sports history in particular.

Iowa as a Litter-Free State : Findings, Implications & Recommendations from the Statewide Litter Surveys, 2002

The research summarized in this report examines: current litter policies and practices of public organizations, the amount and makeup of litter along Iowa roadways, and the opinions of Iowans regarding litter and illegal dumping.

The impact of household size on poverty: An analysis of various low-income townships in the Northern Free State region, South Africa

Poverty is a multi-dimensional socio-economic problem in most sub-Saharan African countries. The purpose of this study is to analyse the relationship between household size and poverty in low-income communities. The Northern Free State region in South Africa was selected as the study region. A sample of approximately 2 900 households was randomly selected within 12 poor communities in the region. A poverty line was calculated and 74% of all households were found to live below the poverty line. The Pearson’s chi-square test indicated a positive relationship between household size and poverty in eleven of the twelve low-income communities. Households below the poverty line presented larger households than those households above the poverty line. This finding is in contradiction with some findings in other African countries due to the fact that South Africa has higher levels of modernisation with less access to land for subsistence farming. Effective provision of basic needs, community facilities and access to assets such as land could assist poor households with better quality of life. Poor households also need to be granted access to economic opportunities, while also receiving adult education regarding financial management and reproductive health.