Background:  The Operational Plan For Comprehensive HIV and AIDS Care, Management and Treatment for South Africa began enrolling patients on April 1, 2004 in the public sector. Criteria for enrollment are a CD4⁺ count <200 and or World Health Organization (WHO) Stage 4. At the outset of the program patients with low CD4⁺ counts were enrolled. We examined trends 18 months later in the CD⁺ counts, age, and gender at the national site of Helen Joseph Hospital (HJH), Johannesburg. This was compared to other models for ART delivery at:  DAI, an employee access program; Reaphela, an NGO-funded, urban clinic; Witkoppen (WHWC) clinic, a semi-urban clinic; and Thusong, a general practitioner network for indigent patients. All of the sites receive funding in part from PEPFAR

Methods:  Using HIV Therapy Edge™ (www.therapyedge.net), we conducted a cross-sectional survey, assessing the gender break down, initiating CD4⁺ count, and age over the period April 2004 to date. This was analyzed in 3-month periods since April 2004 (quarters). Only patients who were initiated in this period were counted. Data were analyzed using SAS Version 9.1.

Results:  A total of 4370 patients were initiated on ART:  3019 at HJH, 519 at DAI, 214 at Reaphela, 225 at WHWC, and 366 at Thusong. The mean age on initiation of treatment was 35 (±9.21) years and was similar at all sites. However, there was a significant downward trend in the age of patients starting ART among the 6 quarters. The difference in means between the first and last quarter was 9.79 years (Bonferroni t-test p <0.005). The mean baseline CD4⁺ count 103 (±105) was constant at all the sites over the 6 quarters. At most sites, the ratio of females to males was >2:1. However, at the employee access program site (DAI), only 45.3% were female. At this site the mean baseline CD4⁺ count, 201.83 (±131.13) was also significantly higher than at the other sites (Bonferroni t-test p <0.005).

Conclusions:  Even with broad-based access to ART, in both the public and private sector, still the very ill are accessing the service. While awareness of HIV is high and the waiting list to access treatment is between 1 and 4 weeks, patients with higher CD4⁺ are not yet accessing service. As the program progresses younger people are starting to access the service. Women are more likely to access ART in all sectors except in the employed sector.