Abstract
Background:Adoption of “Treat All” policies has increased antiretroviral therapy (ART) initiation in sub-Saharan Africa; however, unexplained early losses continue to occur. More information is needed to understand why treatment discontinuation continues at this vulnerable stage in care.Methods:The Monitoring Early Treatment Adherence Study involved a prospective observational cohort of individuals initiating ART at early-stage versus late-stage disease in South Africa and Uganda. Surveys and HIV-1 RNA levels were performed at baseline, 6, and 12 months, with adherence monitored electronically. This analysis included nonpregnant participants in the first 6 months of follow-up; demographic and clinical factors were compared across groups with χ2, univariable, and multivariable models.Results:Of 669 eligible participants, 91 (14%) showed early gaps of ≥30 days in ART use (22% in South Africa and 6% in Uganda) with the median time to gap of 77 days (interquartile range: 43–101) and 87 days (74, 105), respectively. Although 71 (78%) ultimately resumed care, having an early gap was still significantly associated with detectable viremia at 6 months (P ≤ 0.01). Multivariable modeling, restricted to South Africa, found secondary education and higher physical health score protected against early gaps [adjusted odds ratio (aOR) 0.4, 95% confidence interval (CI): 0.2 to 0.8 and (aOR 0.93, 95% CI: 0.9 to 1.0), respectively]. Participants reporting clinics as “too far” had double the odds of early gaps (aOR 2.2: 95% CI: 1.2 to 4.1).Discussion:Early gaps in ART persist, resulting in higher odds of detectable viremia, particularly in South Africa. Interventions targeting health management and access to care are critical to reducing early gaps.
Highlights
Adoption of “Treat All” policies has increased antiretroviral therapy (ART) initiation in sub-Saharan Africa; unexplained early losses continue to occur
Multivariable modeling, restricted to South Africa, found secondary education and higher physical health score protected against early gaps [adjusted odds ratio 0.4, 95% confidence interval (CI): 0.2 to 0.8 and, respectively]
Despite many successes in the global efforts to promote early and enduring treatment, early gaps in ART persist, resulting in higher odds of detectable viremia. These gaps remain significant for key vulnerable populations, in South Africa, where we found 22% (70 of 322 participants) had an early gap in care, compared with 6% in Uganda
Summary
Adoption of “Treat All” policies has increased antiretroviral therapy (ART) initiation in sub-Saharan Africa; unexplained early losses continue to occur. The widespread availability of antiretroviral therapy (ART) throughout sub-Saharan Africa has transformed the HIV epidemic across the region, increasing the number of people on treatment from 100,000 in 2004 to 15.4 million in 2017.1 This increase in availability has dramatically impacted cumulative ART initiation, with some regions experiencing up to a 17.6 percentage point increase from 6–18 months preexpansion to 6–18 months postexpansion.[2] After the adoption of national treat-all policies in 6 sub-Saharan African nations, statistically significant increases in rapid ART initiation were observed in 4 countries, with sustained or amplified improvements in adherence.[3] In South Africa, 70.6% of the 7.9 million people living with HIV (PLWH) ages 15–64 are currently on treatment, with 87.5% of those on treatment virally suppressed.[4] This represents a 2-fold increase in the past decade,[5] accelerated by the expansion in ART eligibility to Treat All as of September 2016.6 In Uganda, where the treatment guidelines were expanded to Treat All as of November 2016,3 treatment initiation numbers are similar with for PLWH ages 15–64 with estimates of 89.3% of PLWH on ART and of which 90.6% are virally suppressed.[7] there are data to suggest the impact of guideline expansions has increased early ART initiation in sub-Saharan Africa,[2,3] early gaps in treatment (ie, discontinuation of $30 days within the first 6 months) persist.[6] The first 6 months of treatment after initiation are crucial to long-
Sign-in/Register to view highlights & summary Sign-in/Register to access full text options 
Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a callMore From: JAIDS Journal of Acquired Immune Deficiency Syndromes
Disclaimer: All third-party content on this website/platform is and will remain the property of their respective owners and is provided on "as is" basis without any warranties, express or implied. Use of third-party content does not indicate any affiliation, sponsorship with or endorsement by them. Any references to third-party content is to identify the corresponding services and shall be considered fair use under The CopyrightLaw.
