Timely initiation of HIV antiretroviral therapy in Haiti 20042018: a retrospective cohort study

Objective. To describe trends in timing of ART initiation for newly diagnosed people living with HIV before and after Haiti adopted its Test and Start policy for universal HIV antiretroviral therapy (ART) in July 2016, and to explore predictors of timely ART initiation for both newly and previously...

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Autores principales:	Nancy Puttkammer, Canada Parrish, Yrvel Desir, Nathaelf Hyppolite, Nadjy Joseph, Lara Hall, Jean Guy Honoré, Ermane Robin, Georges Perrin, Kesner François
Formato:	article
Lenguaje:	EN ES PT
Publicado:	Pan American Health Organization 2021
Materias:	hiv antiretroviral therapy, highly active implementation science haiti Medicine R Arctic medicine. Tropical medicine RC955-962 Public aspects of medicine RA1-1270
Acceso en línea:	https://doaj.org/article/4ed924603969434e8207731219d0a720
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spelling	oai:doaj.org-article:4ed924603969434e8207731219d0a7202021-11-19T15:57:51ZTimely initiation of HIV antiretroviral therapy in Haiti 20042018: a retrospective cohort study1020-49891680-534810.26633/RPSP.2021.139https://doaj.org/article/4ed924603969434e8207731219d0a7202021-11-01T00:00:00Zhttps://iris.paho.org/handle/10665.2/55177https://doaj.org/toc/1020-4989https://doaj.org/toc/1680-5348Objective. To describe trends in timing of ART initiation for newly diagnosed people living with HIV before and after Haiti adopted its Test and Start policy for universal HIV antiretroviral therapy (ART) in July 2016, and to explore predictors of timely ART initiation for both newly and previously diagnosed people living with HIV following Test and Start adoption. Methods. This retrospective cohort study explored timing of ART initiation among 147 900 patients diagnosed with HIV at 94 ART clinics in 20042018 using secondary electronic medical record data. The study used survival analysis methods to assess time trends and risk factors for ART initiation. Results. Timely uptake of ART expanded with Test and Start, such that same-day ART initiation rates increased from 3.7% to 45.0%. However, only 11.0% of previously diagnosed patients initiated ART after Test and Start. In adjusted analyses among newly diagnosed people living with HIV, factors negatively associated with timely ART initiation included being a pediatric patient aged 014 years (HR = 0.23, p > 0.001), being male (HR = 0.92, p = 0.03), being 50+ years (HR = 0.87, p = 0.03), being underweight (HR = 0.79, p > 0.001), and having WHO stage 3 (HR = 0.73, p > 0.001) or stage 4 disease (HR = 0.49, p > 0.001). Variation in timely ART initiation by geographic department and health facility was observed. Conclusions. Haiti has made substantial progress in scaling up Test and Start, but further work is needed to enroll previously diagnosed patients and to ensure rapid ART in key patient subgroups. Further research is needed on facility and geographic factors and on strategies for improving timely ART initiation among vulnerable subgroups.Nancy PuttkammerCanada ParrishYrvel DesirNathaelf HyppoliteNadjy JosephLara HallJean Guy HonoréErmane RobinGeorges PerrinKesner FrançoisPan American Health Organizationarticlehivantiretroviral therapy, highly activeimplementation sciencehaitiMedicineRArctic medicine. Tropical medicineRC955-962Public aspects of medicineRA1-1270ENESPTRevista Panamericana de Salud Pública, Vol 45, Iss 139, Pp 1-11 (2021)
institution	DOAJ
collection	DOAJ
language	EN ES PT
topic	hiv antiretroviral therapy, highly active implementation science haiti Medicine R Arctic medicine. Tropical medicine RC955-962 Public aspects of medicine RA1-1270
spellingShingle	hiv antiretroviral therapy, highly active implementation science haiti Medicine R Arctic medicine. Tropical medicine RC955-962 Public aspects of medicine RA1-1270 Nancy Puttkammer Canada Parrish Yrvel Desir Nathaelf Hyppolite Nadjy Joseph Lara Hall Jean Guy Honoré Ermane Robin Georges Perrin Kesner François Timely initiation of HIV antiretroviral therapy in Haiti 20042018: a retrospective cohort study
description	Objective. To describe trends in timing of ART initiation for newly diagnosed people living with HIV before and after Haiti adopted its Test and Start policy for universal HIV antiretroviral therapy (ART) in July 2016, and to explore predictors of timely ART initiation for both newly and previously diagnosed people living with HIV following Test and Start adoption. Methods. This retrospective cohort study explored timing of ART initiation among 147 900 patients diagnosed with HIV at 94 ART clinics in 20042018 using secondary electronic medical record data. The study used survival analysis methods to assess time trends and risk factors for ART initiation. Results. Timely uptake of ART expanded with Test and Start, such that same-day ART initiation rates increased from 3.7% to 45.0%. However, only 11.0% of previously diagnosed patients initiated ART after Test and Start. In adjusted analyses among newly diagnosed people living with HIV, factors negatively associated with timely ART initiation included being a pediatric patient aged 014 years (HR = 0.23, p > 0.001), being male (HR = 0.92, p = 0.03), being 50+ years (HR = 0.87, p = 0.03), being underweight (HR = 0.79, p > 0.001), and having WHO stage 3 (HR = 0.73, p > 0.001) or stage 4 disease (HR = 0.49, p > 0.001). Variation in timely ART initiation by geographic department and health facility was observed. Conclusions. Haiti has made substantial progress in scaling up Test and Start, but further work is needed to enroll previously diagnosed patients and to ensure rapid ART in key patient subgroups. Further research is needed on facility and geographic factors and on strategies for improving timely ART initiation among vulnerable subgroups.
format	article
author	Nancy Puttkammer Canada Parrish Yrvel Desir Nathaelf Hyppolite Nadjy Joseph Lara Hall Jean Guy Honoré Ermane Robin Georges Perrin Kesner François
author_facet	Nancy Puttkammer Canada Parrish Yrvel Desir Nathaelf Hyppolite Nadjy Joseph Lara Hall Jean Guy Honoré Ermane Robin Georges Perrin Kesner François
author_sort	Nancy Puttkammer
title	Timely initiation of HIV antiretroviral therapy in Haiti 20042018: a retrospective cohort study
title_short	Timely initiation of HIV antiretroviral therapy in Haiti 20042018: a retrospective cohort study
title_full	Timely initiation of HIV antiretroviral therapy in Haiti 20042018: a retrospective cohort study
title_fullStr	Timely initiation of HIV antiretroviral therapy in Haiti 20042018: a retrospective cohort study
title_full_unstemmed	Timely initiation of HIV antiretroviral therapy in Haiti 20042018: a retrospective cohort study
title_sort	timely initiation of hiv antiretroviral therapy in haiti 20042018: a retrospective cohort study
publisher	Pan American Health Organization
publishDate	2021
url	https://doaj.org/article/4ed924603969434e8207731219d0a720
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Timely initiation of HIV antiretroviral therapy in Haiti 20042018: a retrospective cohort study

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