limited health-care access, especially to HIV services.

Good treatment outcomes among foreigners receiving antiretroviral therapy in Johannesburg, South Africa.

Foreigners, including displaced persons, often have limited health-care access, especially to HIV services. Outcomes of antiretroviral therapy (ART) in South Africans and foreigners were compared at a Johannesburg non-governmental clinic. Records were reviewed of 1297 adults enrolled between April 2004 and March 2007 (568 self-identified foreigners, 431 South Africans citizens and 298 with unknown origin). Compared with citizens, foreigners had fewer hospital admissions (39%, 90/303 versus 51%, 126/244; P <>less missed appointments for antiretroviral therapy initiation (20%, 39/200 versus 25%, 51/206; P <>faster median time to antiretroviral therapy initiation (14 versus 21 days, P = 0.008), better retention in care (88%, 325/369 versus 69%, 155/226; P <>lower mortality (2.5%, 14/568 versus 10%, 44/431; P <>foreigners were 55% less likely to fail antiretroviral therapy than citizens (95% CI = 0.23-0.87). These findings support United Nations High Commissioner for Refugees recommendations that antiretroviral therapy should not be withheld from displaced persons.

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Editors’ note: South Africa at the end of 2007 had the world’s largest number of pending asylum applications and was second only to the United States of America in annual new asylum claims. The level of undocumented migrants is much higher. The findings from this study demonstrate that foreigners were about half as likely to fail antiretroviral treatment as citizens, despite having lower baseline median CD4 cell counts and being subject to significant hurdles in accessing and staying in care. This strongly supports the argument that foreigners should be included in the ‘right to access antiretroviral treatment for all.