Adult Clinical and Immunologic Outcomes of the National Antiretroviral Treatment Program in Rwanda During 2004-2005

BACKGROUND: By December 2007 over 48000 persons had initiated antiretroviral treatment (ART) at 171 clinics in Rwanda. Assessing national ART program outcomes is essential to determine whether programs have the desired impact. METHODS: We conducted a retrospective cohort study to assess key 6- and 12-month outcomes among a nationally representative stratified random sample of 3194 adults (> or =15 years) who initiated ART from January 1 2004 through December 31 2005. FINDINGS: At ART initiation the median patient age was 37 years and 65% were female. Overall the baseline median CD4 cell count was 141 cells per microliter. At 6 and 12 months after ART initiation 92% and 86% of patients respectively remained on ART at their original site. By 6 months 3.6% were dead and 3.4% were lost to follow-up; by 12 months 4.6% were dead and 4.9% were lost to follow-up. Among patients with available follow-up CD4 cell count data median CD4 cell counts increased by 98 cells per microliter and 119 cells per microliter at 6 and 12 months after ART initiation respectively. CONCLUSIONS: Rwandas national ART program achieved excellent 6- and 12-month retention and immunologic outcomes during the first 2 years of rapid scale-up. Routine supervision is required to improve compliance with clinical guidelines and data quality.