HIV This Week

Van der Borght SF, Clevenbergh P, Rijckborst H, Nsalou P, Onyia N, Lange JM, de Wit TF, Van der Loeff MF. Mortality and morbidity among HIV type-1-infected patients during the first 5 years of a multicountry HIV workplace programme in Africa. Antivir Ther. 2009;14(1):63-74.

Van der Borght and colleagues aimed to evaluate the effectiveness of an HIV workplace programme in sub-Saharan Africa. The international brewing company, Heineken, introduced an HIV workplace programme in its African subsidiaries in 2001. Beneficiaries from 16 sites in 5 countries were eligible. HIV type-1 (HIV-1)-infected individuals were assessed clinically and immunologically, and started highly active antiretroviral therapy if they had AIDS or had a CD4+ T-cell count <300 cells/microl. In this cohort, study patients were followed-up for vital status, new AIDS events, CD4+ T-cell count, and haemoglobin. Over the first 5 years of the programme, 431 adults were found to be HIV-1-infected. The mortality rate among those not yet taking highly active antiretroviral therapy was 2.6 per 100 person-years of observation. By October 2006, 249 patients had started highly active antiretroviral therapy at a median CD4+ T-cell count of 170 cells/microl; 59 (23.7%) patients were in CDC stage C. Among patients on highly active antiretroviral therapy, 25 died and 7 were lost to follow-up. The mortality rate was 3.7 per 100 person-years of observation overall, 14 per 100 person-years of observation in the first 16 weeks and 2.5 per 100 person-years of observation thereafter (P < 0.0001). At 4 years after start of treatment, 89% of patients were known to be alive. The CD4+ T-cell count increased by a median of 153 and 238 cells/microl after 1 and 4 years of highly active antiretroviral therapy, respectively. In this HIV workplace programme in sub-Saharan Africa, long-term high survival was achieved.

Editors’ note: Leading the way forward for private sector engagement in HIV in Africa, this private sector company began implementing an HIV workplace programme in May 2001 in Nigeria, Rwanda, Burundi, Republic of Congo, and Democratic Republic of Congo. Not only its own direct staff but also the African staffs of its subsidiaries, their spouses, and their children are entitled to free healthcare by the company. With voluntary and confidential HIV testing, assessment for treatment initiation, no drug stock-outs, and good treatment durability with low loss to follow-up, this small but well-managed and adequately funded programme achieved excellent treatment outcomes over 5 years. This is a good example of corporate social responsibility in action – cheers!