HIV Treatment Outcomes Among Patients Initiated on Antiretroviral Therapy Pre and Post-Universal Test and Treat Guidelines in South Africa

Kamban Hirasen, 1 Matthew P Fox, 1–3 Cheryl J Hendrickson, 1 Tembeka Sineke, 1 Dorina Onoya 1 1Health Economics and Epidemiology Research Office, Department of Internal Medicine, School of Clinical Medicine, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South...

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Autores principales:	Hirasen K, Fox MP, Hendrickson CJ, Sineke T, Onoya D
Formato:	article
Lenguaje:	EN
Publicado:	Dove Medical Press 2020
Materias:	universal access antiretroviral therapy lost to follow-up virologic suppression resource-limited settings south africa Therapeutics. Pharmacology RM1-950
Acceso en línea:	https://doaj.org/article/e1d87a3e93e74effa0ef6c223085cf86
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spelling	oai:doaj.org-article:e1d87a3e93e74effa0ef6c223085cf862021-12-02T12:24:53ZHIV Treatment Outcomes Among Patients Initiated on Antiretroviral Therapy Pre and Post-Universal Test and Treat Guidelines in South Africa1178-203Xhttps://doaj.org/article/e1d87a3e93e74effa0ef6c223085cf862020-03-01T00:00:00Zhttps://www.dovepress.com/hiv-treatment-outcomes-among-patients-initiated-on-antiretroviral-ther-peer-reviewed-article-TCRMhttps://doaj.org/toc/1178-203XKamban Hirasen, 1 Matthew P Fox, 1–3 Cheryl J Hendrickson, 1 Tembeka Sineke, 1 Dorina Onoya 1 1Health Economics and Epidemiology Research Office, Department of Internal Medicine, School of Clinical Medicine, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa; 2Department of Global Health, Boston University School of Public Health, Boston, MA, USA; 3Department of Epidemiology, Boston University School of Public Health, Boston, MA, USACorrespondence: Dorina OnoyaHealth Economics and Epidemiology Research Office, 39 Empire Road, Empire Park, Parktown, Johannesburg 2193, South AfricaTel +27 010 001 7936Email donoya@heroza.orgIntroduction: Officially rolled out on 01 September 2016, South Africa’s Universal Test and Treat (UTT) policy calls for first-line antiretroviral treatment (ART) initiation among all known HIV-positive patients, irrespective of CD4 cell count. We evaluate treatment outcomes of patients initiated on first-line ART directly before and after the implementation of UTT.Methods: We analysed prospectively collected clinical cohort data among ART-naïve adult patients within two HIV clinics in Johannesburg, South Africa. We compare two groups: 1) an unexposed pre-UTT group initiating treatment from 01 December 2014 to 31 May 2015; and 2) an exposed UTT group initiating treatment from 01 December 2016 to 31 May 2017. Primary treatment outcomes included lost to follow-up (LTFU) (> 90 days late for the last scheduled visit with no subsequent clinical visit). Cox proportional hazards models were used to estimate the association between pre-UTT vs UTT initiation on LTFU by 12 months.Results: We included 2410 patients. A total of 1267 (52.6%) patients initiated ART before UTT implementation and 1143 (47.4%) after the change in policy. LTFU (adjusted Hazard Ratio (aHR): 1.51; 95% Confidence Interval (CI): 1.16– 1.98) between groups and specifically among those initiating with a CD4 cell count ≤ 500 cells/mm 3 (aHR: 1.59; 95% CI: 1.21– 2.10) was higher among patients initiating ART under UTT.Conclusion: LTFU under UTT proved higher than that of previous periods. Patients initiating first-line therapy under the treat-all policy may often start treatment in better health, subsequently not perceiving a direct benefit to treatment which may deter patients from consistent engagement in HIV treatment programmes.Keywords: universal access, antiretroviral therapy, lost to follow-up, virologic suppression, resource-limited settings, South AfricaHirasen KFox MPHendrickson CJSineke TOnoya DDove Medical Pressarticleuniversal accessantiretroviral therapylost to follow-upvirologic suppressionresource-limited settingssouth africaTherapeutics. PharmacologyRM1-950ENTherapeutics and Clinical Risk Management, Vol Volume 16, Pp 169-180 (2020)
institution	DOAJ
collection	DOAJ
language	EN
topic	universal access antiretroviral therapy lost to follow-up virologic suppression resource-limited settings south africa Therapeutics. Pharmacology RM1-950
spellingShingle	universal access antiretroviral therapy lost to follow-up virologic suppression resource-limited settings south africa Therapeutics. Pharmacology RM1-950 Hirasen K Fox MP Hendrickson CJ Sineke T Onoya D HIV Treatment Outcomes Among Patients Initiated on Antiretroviral Therapy Pre and Post-Universal Test and Treat Guidelines in South Africa
description	Kamban Hirasen, 1 Matthew P Fox, 1–3 Cheryl J Hendrickson, 1 Tembeka Sineke, 1 Dorina Onoya 1 1Health Economics and Epidemiology Research Office, Department of Internal Medicine, School of Clinical Medicine, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa; 2Department of Global Health, Boston University School of Public Health, Boston, MA, USA; 3Department of Epidemiology, Boston University School of Public Health, Boston, MA, USACorrespondence: Dorina OnoyaHealth Economics and Epidemiology Research Office, 39 Empire Road, Empire Park, Parktown, Johannesburg 2193, South AfricaTel +27 010 001 7936Email donoya@heroza.orgIntroduction: Officially rolled out on 01 September 2016, South Africa’s Universal Test and Treat (UTT) policy calls for first-line antiretroviral treatment (ART) initiation among all known HIV-positive patients, irrespective of CD4 cell count. We evaluate treatment outcomes of patients initiated on first-line ART directly before and after the implementation of UTT.Methods: We analysed prospectively collected clinical cohort data among ART-naïve adult patients within two HIV clinics in Johannesburg, South Africa. We compare two groups: 1) an unexposed pre-UTT group initiating treatment from 01 December 2014 to 31 May 2015; and 2) an exposed UTT group initiating treatment from 01 December 2016 to 31 May 2017. Primary treatment outcomes included lost to follow-up (LTFU) (> 90 days late for the last scheduled visit with no subsequent clinical visit). Cox proportional hazards models were used to estimate the association between pre-UTT vs UTT initiation on LTFU by 12 months.Results: We included 2410 patients. A total of 1267 (52.6%) patients initiated ART before UTT implementation and 1143 (47.4%) after the change in policy. LTFU (adjusted Hazard Ratio (aHR): 1.51; 95% Confidence Interval (CI): 1.16– 1.98) between groups and specifically among those initiating with a CD4 cell count ≤ 500 cells/mm 3 (aHR: 1.59; 95% CI: 1.21– 2.10) was higher among patients initiating ART under UTT.Conclusion: LTFU under UTT proved higher than that of previous periods. Patients initiating first-line therapy under the treat-all policy may often start treatment in better health, subsequently not perceiving a direct benefit to treatment which may deter patients from consistent engagement in HIV treatment programmes.Keywords: universal access, antiretroviral therapy, lost to follow-up, virologic suppression, resource-limited settings, South Africa
format	article
author	Hirasen K Fox MP Hendrickson CJ Sineke T Onoya D
author_facet	Hirasen K Fox MP Hendrickson CJ Sineke T Onoya D
author_sort	Hirasen K
title	HIV Treatment Outcomes Among Patients Initiated on Antiretroviral Therapy Pre and Post-Universal Test and Treat Guidelines in South Africa
title_short	HIV Treatment Outcomes Among Patients Initiated on Antiretroviral Therapy Pre and Post-Universal Test and Treat Guidelines in South Africa
title_full	HIV Treatment Outcomes Among Patients Initiated on Antiretroviral Therapy Pre and Post-Universal Test and Treat Guidelines in South Africa
title_fullStr	HIV Treatment Outcomes Among Patients Initiated on Antiretroviral Therapy Pre and Post-Universal Test and Treat Guidelines in South Africa
title_full_unstemmed	HIV Treatment Outcomes Among Patients Initiated on Antiretroviral Therapy Pre and Post-Universal Test and Treat Guidelines in South Africa
title_sort	hiv treatment outcomes among patients initiated on antiretroviral therapy pre and post-universal test and treat guidelines in south africa
publisher	Dove Medical Press
publishDate	2020
url	https://doaj.org/article/e1d87a3e93e74effa0ef6c223085cf86
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HIV Treatment Outcomes Among Patients Initiated on Antiretroviral Therapy Pre and Post-Universal Test and Treat Guidelines in South Africa

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