Abstract
The benefits of antiretroviral therapy (ART) for persons living with HIV (PLWH) are well established. Rapid ART initiation can lead to improved clinical outcomes. Portugal has one of the highest rates of new HIV diagnoses in the European Union, and an average time until ART initiation above the recommendations established by the national guideline according to data from the first two years after its implementation in 2015, with no more recent data available after that. This study aimed to evaluate time from the first hospital appointment until ART initiation among newly diagnosed HIV patients in Portugal between 2017 and 2018, to investigate differences between hospitals, and to understand the experience of patient associations in supporting the navigation of PLWH throughout referral and linkage to the therapeutic process. To answer to these objectives, a twofold design was followed: a quantitative approach, with an analysis of records from five Portuguese hospitals, and a qualitative approach, with individual interviews with three representatives of patient associations. Overall, 847 and 840 PLWH initiated ART in 2017 and in 2018, respectively, 21 days (median of the two years) after the first appointment, with nearly half coming outside the mainstream service for hospital referral, and with observed differences between hospitals. In 2017–2018, only 38.0% of PLWH initiated ART in less than 14 days after the first hospital appointment. From the interviews, barriers of administrative and psychosocial nature were identified that may hinder access to ART. Patient associations work to offer a tailored support to patients’ navigation within the health system, which can help to reduce or overcome those potential barriers. Indicators related to time until ART initiation can be used to monitor and improve access to specialized care of PLWH.
Highlights
Since 1997, clinical efficacy and safety of a three-drug regimen, the highly active antiretroviral therapy (HAART), have been demonstrated to be effective in reducing the progression of HIV disease, as well as in decreasing AIDS incidence and mortality [1,2,3].For persons living with HIV (PLWH), the benefit of antiretroviral therapy (ART) was determined by a large cohort study [4]
Notwithstanding, rapid ART initiation has proven to lead to better clinical outcomes and to important benefits in settings where there are long delays due to extensive patient preparation prior to ART initiation [13,14,15]
Same-day ART initiation may shorten the time to virologic suppression, improving retention in care with virologic suppression among patients with early clinical HIV diseases [13,14,16]
Summary
For persons living with HIV (PLWH), the benefit of antiretroviral therapy (ART) was determined by a large cohort study [4]. Notwithstanding, rapid ART initiation has proven to lead to better clinical outcomes (e.g., increased virologic suppression and retention in care, improved quality of life, AIDS- and non-AIDS-related morbidity and mortality prevention) and to important benefits in settings where there are long delays due to extensive patient preparation prior to ART initiation [13,14,15]. Treatment for PLWH can be initiated on the day of the diagnosis without any impact on ART safety or acceptability [13]. Same-day ART initiation may shorten the time to virologic suppression, improving retention in care with virologic suppression among patients with early clinical HIV diseases [13,14,16]. The rapid initiation of ART, including sameday ART, is a World Health Organization recommendation [17,18]
Sign-in/Register to view highlights & summary 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 callDisclaimer: 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.
