Predictors of Clinical Outcomes among People with HIV and Tuberculosis Symptoms after Rapid Treatment Initiation in Haiti

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Abstract Introduction Few studies have evaluated baseline predictors of clinical outcomes among people with HIV starting antiretroviral therapy (ART) in the modern era of rapid ART initiation. Methods We conducted a secondary analysis of a previously reported open-label randomized controlled trial of two rapid treatment initiation strategies for people with treatment-naïve HIV and tuberculosis symptoms at a large urban clinic in Haiti. We used logistic regression models to assess associations between baseline characteristics and (1) retention in care at 48 weeks, (2) HIV viral load suppression at 48 weeks (among participants who underwent viral load testing), and (3) all-cause mortality. For the viral load suppression outcome, we used inverse probability weighting to account for potential selection bias resulting from exclusion of participants who did not undergo viral load testing. Results A total of 500 participants were enrolled in the study 11/2017-1/2020. Eighty-eight (18%) participants were diagnosed with tuberculosis, and ART was started in 494 (99%). After multivariable adjustment, less than secondary education (adjusted odds ratio [AOR] 0.21, 95% CI 0.10 to 0.46) was significantly associated with a reduced odds of retention in care. Dolutegravir initiation (AOR 2.57, 95% CI 1.22 to 5.43), age (AOR 1.42 per 10-yearincrease, 95% CI 1.01 to 1.99), and tuberculosis diagnosis (AOR 3.92, 95% CI 1.36 to 11.28) were significantly associated with increased odds of retention. Age (AOR 1.36, 95% CI 1.05 to 1.75) and dolutegravir initiation (AOR 1.75, 95% CI 1.07 to 2.85) were positively associated with viral suppression, and tuberculosis diagnosis (AOR 0.50, 95% CI 0.28 to 0.89) was negatively associated with viral suppression, with similar findings after incorporation of inverse probability weights. Higher CD4 cell count at enrollment was significantly associated with a lower odds of mortality (unadjusted odds ratio [OR] 0.69, 95% CI 0.55 to 0.87), and anemia was associated with a significantly greater odds of mortality (OR 4.86, 95% CI 1.71 to 13.81). Conclusions We identified sociodemographic, treatment-related, clinical, and laboratory-based predictors of clinical outcomes. These characteristics may serve as markers of sub-populations that could benefit from additional interventions to support treatment success after rapid treatment initiation.