Abstract
BackgroundThrough universal “test and treat approach” (UTT) it is believed that HIV new infection and AIDS related death will be reduced at community level and through time HIV can be eliminated. With this assumption the UTT program was implemented since 2016. However, the effect of this program in terms of individual patient survival and treatment outcome was not assessed in relation to the pre-existing defer treatment approach.ObjectiveTo assess the effects of UTT program on HIV treatment outcomes and patient survival among a cohort of adult HIV infected patients taking antiretroviral treatment in Gurage zone health facilities.MethodsInstitution based retrospective cohort study was conducted in facilities providing HIV care and treatment. Eight years (2012–2019) HIV/AIDS treatment records were included in the study. Five hundred HIV/AIDS treatment records were randomly selected and reviewed. Data were abstracted using standardized checklist by trained health professionals; then it was cleaned, edited and entered by Epi info version 7 and analyzed by STATA. Cox model was built to estimate survival differences across different study variables.ResultsA total of 500 patients were followed for 1632.6 person-year (PY) of observation. The overall incidence density rate (IDR) of death in the cohort was 3 per-100-PY. It was significantly higher for differed treatment program, which is 3.8 per-100-PY compared to 2.4 per-100-PY in UTT program with a p value of 0.001. The relative risk of death among differed cases was 1.58 times higher than the UTT cases. The cumulative probability of survival at the end of 1st, 2nd, 3rd, and 4th years was 98%, 90.2%, 89.2% and 88% respectively with difference between groups. The log rank test and Kaplan–Meier survival curve indicated patients enrolled in the UTT program survived longer than patients enrolled in the differed treatment program (log rank X2 test = 4.1, p value = 0.04). Age, residence, base line CD4 count, program of enrolment, development of new OIS and treatment failure were predicted mortality from HIV infection.ConclusionMortality was significantly reduced after UTT. Therefore, intervention to further reduce deaths has to focus on early initiation of treatment and strengthening UTT programs.
Highlights
Through universal “test and treat approach” (UTT) it is believed that Human immunodeficiency virus (HIV) new infection and AIDS related death will be reduced at community level and through time HIV can be eliminated
The overall incidence density rate (IDR) of death in the cohort was 3 per-100-PY. It was significantly higher for differed treatment program, which is 3.8 per-100-PY compared to 2.4 per-100-PY in UTT program with a p value of 0.001
The log rank test and Kaplan–Meier survival curve indicated patients enrolled in the UTT program survived longer than patients enrolled in the differed treatment program
Summary
Through universal “test and treat approach” (UTT) it is believed that HIV new infection and AIDS related death will be reduced at community level and through time HIV can be eliminated. With this assumption the UTT program was implemented since 2016. World Health Organization (WHO) developed the “universal test and treat” (UTT) program as strategy for HIV elimination in place of the previous “differed treatment” (CD4 based and WHO clinical staging approaches) program [3,4,5,6]. Assuring the individual level benefit of the program in terms of treatment outcome and patient survival is very important to bring additional evidence helpful for scaling up program intervention
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