Skip to main content

Free Content Adoption of new HIV treatment guidelines and drug substitutions within first‐line as a measure of quality of care in rural Lesotho: health centers and hospitals compared

Download Article:

You have access to the full text article on a website external to Ingenta Connect.

Please click here to view this article on Wiley Online Library.

You may be required to register and activate access on Wiley Online Library before you can obtain the full text. If you have any queries please visit Wiley Online Library


Objective  In 2007, Lesotho launched new national antiretroviral treatment (ART) guidelines, prioritising tenofovir and zidovudine over stavudine as a backbone together with lamivudine. We compared the rate of adoption of these new guidelines and substitution of first‐line drugs by health centers (HC) and hospitals in two catchment areas in rural Lesotho.

Methods  Retrospective cohort analysis. Patients aged ≥16 years were stratified into a HC‐ and a hospital‐group. Main outcome variables: Type of backbone at ART‐initiation (i), substitutions within first line (ii) and type of backbone among patients retained by December 2010 (iii). A multiple logistic regression model including HC vs. hospital, patient characteristics (sex, age, WHO‐stage, baseline CD4‐count, concurrent pregnancy, concurrent tuberculosis treatment) and year of ART‐start, was used.

Results  Of 3936 adult patients initiated on ART between 2007 and 2010, 1971 started at hospitals and 1965 at HCs. Hospitals were more likely to follow the new guidelines as measured by prescription of backbones without stavudine (Odds‐ratio 1.55; 95%CI: 1.32–1.81) and had a higher rate of drug substitutions while on first‐line ART (2.39; 1.83–3.13). By December 2010, patients followed at health centres were more likely to still receive stavudine (2.28; 1.83–2.84).

Conclusions  Health centers took longer to adopt the new guidelines and substituted drugs less frequently. Decentralised ART‐programmes need close support, supervision and mentoring to absorb new guidelines and to adhere to them.
No References
No Citations
No Supplementary Data
No Article Media
No Metrics

Language: English

Document Type: Research Article

Affiliations: 1:  SolidarMed, Maseru, Lesotho 2:  Seboche Hospital, Botha-Bothe, Lesotho 3:  SolidarMed, Lucerne, Switzerland 4:  Institute of Tropical Medicine, Antwerp, Belgium

Publication date: 01 October 2012

  • Access Key
  • Free content
  • Partial Free content
  • New content
  • Open access content
  • Partial Open access content
  • Subscribed content
  • Partial Subscribed content
  • Free trial content
Cookie Policy
Cookie Policy
Ingenta Connect website makes use of cookies so as to keep track of data that you have filled in. I am Happy with this Find out more