However, expanding treatment programmes are now facing increases in the number of patients failing treatment.
1. For optimal clinical outcomes, adherence to ART should be greater than 95% (1-2 missed doses per month); when adherence falls below 80% (more than 6 missed doses per month), detectable viral loads begin to appear.
2. Prolonged periods of replicating virus in the presence of suboptimal levels of ART in the bloodstream allow the virus to develop mutations that lead to resistance to the different classes of ART.
In February 2012, Doctors Without Borders (MSF) partnered with Western Cape Government Health to pilot a ‘risk of treatment failure’ intervention at a large community health centre ART clinic. Ubuntu Clinic provides ART to close to 7 000 adult patients, of whom approximately 10% are currently receiving second-line treatment.