Same-Day Antiretroviral Therapy (ART) Initiation as a Predictor of Loss to Follow-up and Viral Suppression Among People Living With Human Immunodeficiency Virus (HIV) in Sub-Saharan Africa

被引：11

作者：

Ross, Jonathan ^{[1
,2
]}

Brazier, Ellen ^{[3
,4
]}

Fatti, Geoffrey ^{[5
,6
]}

Jaquet, Antoine ^{[7
]}

Tanon, Aristophane ^{[8
]}

Haas, Andreas D. ^{[9
]}

Diero, Lameck ^{[10
,11
]}

Castelnuovo, Barbara ^{[10
,11
]}

Yiannoutsos, Constantin T. ^{[12
]}

Nash, Denis ^{[3
,4
]}

Anastos, Kathryn M. ^{[1
,2
]}

Yotebieng, Marcel ^{[1
,2
]}

机构：

[1] Albert Einstein Coll Med, Div Gen Internal Med, Dept Med, Bronx, NY 10467 USA

[2] Montefiore Hlth Syst, Bronx, NY USA

[3] CUNY, Inst Implementat Sci Populat Hlth, New York, NY 10021 USA

[4] CUNY, Grad Sch Publ Hlth & Hlth Policy, New York, NY 10021 USA

[5] KhethImpilo AIDS Free Living, Cape Town, South Africa

[6] Stellenbosch Univ, Fac Med & Hlth Sci, Dept Global Hlth, Div Epidemiol & Biostat, Cape Town, South Africa

[7] Univ Bordeaux, Natl Inst Hlth & Med Res INSEAM, UMR 1219, Res Inst Sustainable Dev IRD,EMR 271,Bordeaux Pop, Bordeaux, France

[8] Treichville Teaching Hosp, Serv Malad Infect & Trop SMIT, Abidjan, Cote Ivoire

[9] Univ Bern, Inst Social & Prevent Med ISPM, Bern, Switzerland

[10] Moi Univ, Dept Med, Sch Med, Eldoret, Kenya

[11] Moi Teaching & Referral Hosp, Eldoret, Kenya

[12] Indiana Univ, Fairbanks Sch Publ Hlth, Indianapolis, IN USA

来源：

CLINICAL INFECTIOUS DISEASES | 2023年 / 76卷 / 01期

基金：

美国国家卫生研究院; 瑞士国家科学基金会;

关键词：

antiretroviral therapy; Treat-All; sub-Saharan Africa; loss to follow-up; PREVENTION; CARE;

D O I：

10.1093/cid/ciac759

中图分类号：

R392 [医学免疫学]; Q939.91 [免疫学];

学科分类号：

100102 ;

摘要：

Background Treat-All guidelines recommend initiation of antiretroviral therapy (ART) for all people living with HIV (PLWH) on the day of diagnosis when possible, yet uncertainty exists about the impact of same-day ART initiation on subsequent care engagement. We examined the association of same-day ART initiation with loss to follow-up and viral suppression among patients in 11 sub-Saharan African countries. Methods We included ART-naive adult PLWH from sites participating in the International epidemiology Databases to Evaluate AIDS (IeDEA) consortium who enrolled in care after Treat-All implementation and prior to January 2019. We used multivariable Cox regression to estimate the association between same-day ART initiation and loss to follow-up and Poisson regression to estimate the association between same-day ART initiation and 6-month viral suppression. Results Among 29 017 patients from 63 sites, 18 584 (64.0%) initiated ART on the day of enrollment. Same-day ART initiation was less likely among those with advanced HIV disease versus early-stage disease. Loss to follow-up was significantly lower among those initiating ART >= 1 day of enrollment, compared with same-day ART initiators (20.6% vs 27.7%; adjusted hazard ratio: .66; 95% CI .57-.76). No difference in viral suppression was observed by time to ART initiation (adjusted rate ratio: 1.00; 95% CI: .98-1.02). Conclusions Patients initiating ART on the day of enrollment were more frequently lost to follow-up than those initiating later but were equally likely to be virally suppressed. Our findings support recent World Health Organization recommendations for providing tailored counseling and support to patients who accept an offer of same-day ART. Among newly enrolling patients from diverse HIV service delivery settings in sub-Saharan Africa, a substantially higher proportion of patients initiating ART on the day of enrollment were lost to follow-up compared with those who initiated ART later.

引用

页码：39 / 47

页数：9

共 35 条

[21] Same-day HIV testing with initiation of antiretroviral therapy versus standard care for persons living with HIV: A randomized unblinded trial [J].