Introduction and evaluation of a 'pre-ART care' service in Swaziland: an operational research study


Objective: To implement and evaluate a formal pre-antiretroviral therapy (ART) care service at a district hospital in Swaziland.

Design: Operational research.

Setting: District hospital in Southern Africa.

Participants: 1171 patients with a previous diagnosis of HIV. A baseline patient group consisted of the first 200 patients using the service. Two follow-up groups were defined: group 1 was all patients recruited from April to June 2009 and group 2 was 200 patients recruited in February 2010.

Intervention: Introduction of pre-ART care—a package of interventions, including counselling; regular review; clinical staging; timely initiation of ART; social and psychological support; and prevention and management of opportunistic infections, such as tuberculosis.

Primary and secondary outcome measures: Proportion of patients assessed for ART eligibility, proportion of eligible patients who were started on ART and proportion receiving defined evidence-based interventions (including prophylactic co-trimoxazole and tuberculosis screening).

Results: Following the implementation of the pre-ART service, the proportion of patients receiving defined interventions increased; the proportion of patient being assessed for ART eligibility significantly increased (baseline: 59%, group 1: 64%, group 2: 76%; p=0.001); the proportion of ART-eligible patients starting treatment increased (baseline: 53%, group 1: 81%, group: 2, 81%; p


Burtle, D.; Welfare, W.; Elden, S.; Mamvura, C.; Vandalanotte, J.; Petherick, E.; Walley, J.; Wright, J. Introduction and evaluation of a ‘pre-ART care’ service in Swaziland: an operational research study. BMJ Open (2012) 2 (2) e000195. [DOI: 10.1136/bmjopen-2011-000195]

Introduction and evaluation of a ‘pre-ART care’ service in Swaziland: an operational research study

Published 1 January 2012