Abstract
Monitoring prevalence of advanced human immunodeficiency virus (HIV) disease (i.e., CD4+ T-cell count <200 cells/μL) among persons starting antiretroviral therapy (ART) is important to understand ART program outcomes, inform HIV prevention strategy, and forecast need for adjunctive therapies.*,†,§ To assess trends in prevalence of advanced disease at ART initiation in 10 high-burden countries during 2004-2015, records of 694,138 ART enrollees aged ≥15 years from 797 ART facilities were analyzed. Availability of national electronic medical record systems allowed up-to-date evaluation of trends in Haiti (2004-2015), Mozambique (2004-2014), and Namibia (2004-2012), where prevalence of advanced disease at ART initiation declined from 75% to 34% (p<0.001), 73% to 37% (p<0.001), and 80% to 41% (p<0.001), respectively. Significant declines in prevalence of advanced disease during 2004-2011 were observed in Nigeria, Swaziland, Uganda, Vietnam, and Zimbabwe. The encouraging declines in prevalence of advanced disease at ART enrollment are likely due to scale-up of testing and treatment services and ART-eligibility guidelines encouraging earlier ART initiation. However, in 2015, approximately a third of new ART patients still initiated ART with advanced HIV disease. To reduce prevalence of advanced disease at ART initiation, adoption of World Health Organization (WHO)-recommended "treat-all" guidelines and strategies to facilitate earlier HIV testing and treatment are needed to reduce HIV-related mortality and HIV incidence.
Highlights
Monitoring prevalence of advanced human immunodeficiency virus (HIV) disease (i.e., CD4+ T-cell count
In Mozambique (2004–2014), Namibia (2004–2012), and Haiti (2004–2015), prevalence of advanced disease at ART initiation declined from 73% to 37% (p
For those antiretroviral therapy (ART) enrollees who do initiate ART late (3), ensuring availability of WHOrecommended adjunctive therapies could help reduce morbidity and mortality during ART
Summary
Trends in Prevalence of Advanced HIV Disease at Antiretroviral Therapy Enrollment — 10 Countries, 2004–2015. Tippett Barr, DrPH35; Elizabeth Gonese, MPH35; Tsitsi Mutasa-Apollo, MBChB34; Shirish Balachandra, MD35; Stephanie Behel, PhD1; Trista Bingham, PhD1; Duncan Mackellar, DrPH1; David Lowrance, MD21; Tedd V. Availability of national electronic medical record systems allowed up-to-date evaluation of trends in Haiti (2004–2015), Mozambique (2004–2014), and Namibia (2004–2012), where prevalence of advanced disease at ART initiation declined from 75% to 34% (p
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