Abstract
Background: World Health Organization (WHO) (2015) recommended that all people diagnosed with human immunodeficiency virus (HIV)-positive initiate Highly Active Anti Retroviral Therapy (HAART) immediately (less than a week), irrespective of CD4 count (Universal Test and Treat / UTT) Program. Objective: To evaluate the impact of UTT as a current therapeutic program on HIV treatment outcomes, coverage, adherence, and lost to follow-up (LTFU) at Wangaya Hospital in Denpasar, Bali, Indonesia. Methods: A Retrospective cohort study was conducted during July 2017 - June 2018 (Pre-UTT) and September 2018 – August 2019 (Post-UTT). Around 402 medical records were selected, reviewed, and enrolled. Data were analyzed using SPSS software for windows version 24.0. Bivariate analysis (Chi-square test) was performed on all variables with a statistically significant t level of 0.05. Results: Among 4,322 new visitors; 3,585 (82.95%) agreed to take HIV test and 402(11.21%) were confirmed HIV reactive. Most participants confirmed HIV reactive occured at age 25-34 years old and 230 (57.21%) were male. The majority education level were primary (Junior high school) 302(75.12%), 379(94.28%) were employed and 281 (69.90%) stayed in Denpasar. About 350 (87.06%) received HAART, 298 (85.14%) with high adherence and 52 (14.86%) LTFU. Pre-UTT, HAART coverage; 83.03% (181), were statistically significant increased to 91.85% (169) post UTT (p=0.000). High adherence pre-UTT; 79.56% (144) was significantly increased to 91.12% (154) post UTT (p=0.006) and LTFU were significantly decreased; 20.44% (37) to 8.87% (15) (p=0.006). Conclusion: UTT program significantly improve the HIV treatment outcome (increased coverage, adherence, and decreased LTFU).
Highlights
Based on the findings of the joint Indonesian and International Review Team, the Ministry of Health should consider expanding eligibility for antiretroviral therapy (ART) to all people living with human immunodeficiency virus (HIV), regardless of CD4 count [12]
The people at risk are screened for HIV infection, whereas people who are diagnosed with HIV infection are given early Highly Active Anti Retroviral Therapy (HAART)
A retrospective cohort study was conducted during July 2017- June 2018 (Pre-Universal Test and Treat (UTT)) and September 2018 - August 2019 (Post-UTT) at Merpati Clinic at Wangaya Hospital in Denpasar, Bali, Indonesia, which included a total of 402 participants
Summary
In 2016, only 32.1% of (69,954 of the 217,631) HIV patients were receiving ARV therapy This coverage is inadequate to accomplish the 2020 objectives [11]. Universal Test and Treat (UTT) is a current HIV therapy program that gives HAART as soon as possible, irrespective of CD4 cell count. The HIV outcome improvement (increased the coverage, adherence and decreased the lost to follow up, viral suppression, reduce HIV transmission to other people, and increased quality of life) is the target of UTT [13 - 17]. World Health Organization (WHO) (2015) recommended that all people diagnosed with human immunodeficiency virus (HIV)-positive initiate Highly Active Anti Retroviral Therapy (HAART) immediately (less than a week), irrespective of CD4 count (Universal Test and Treat / UTT) Program
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