scholarly journals The impact of same-day antiretroviral therapy initiation under the WHO Treat-All policy

2020 ◽  
Author(s):  
Bernhard Kerschberger ◽  
Andrew Boulle ◽  
Rudo Kuwengwa ◽  
Iza Ciglenecki ◽  
Michael Schomaker
Keyword(s):  
Antiretroviral Therapy ◽  
Likelihood Estimation ◽  
Directed Acyclic Graphs ◽  
World Health ◽  
Hiv Care ◽  
People Living With Hiv ◽  
Unfavourable Outcome ◽  
Old Patients ◽  
Treat All ◽  
The Impact

ABSTRACTBackgroundThe World Health Organization recommends rapid initiation of antiretroviral therapy (ART) for people living with HIV, with the option to start treatment on the day of diagnosis (same-day-ART). However, the effect of same-day-ART remains unknown in realistic public sector settings.MethodsWe established a cohort of ≥16-year-old patients who initiated first-line ART under Treat-All in Eswatini between 2014-2016, either on the day of HIV care enrolment (same-day-ART) or 1–14 days thereafter (early-ART). Directed acyclic graphs, flexible parametric survival analysis and targeted maximum likelihood estimation (TMLE) were used to estimate the effect of same-day ART initiation on the composite unfavourable treatment outcome (loss to follow-up;death;viral failure).ResultsOf 1328 patients, 839 (63.2%) initiated same-day ART. The adjusted hazard ratio of the unfavourable outcome was increased by 48% (95% CI:1.16–1.89) for same-day ART compared with early ART. TMLE suggested that after 1 year, 28.9% of patients would experience the unfavourable outcome under same-day ART compared with 21.2% under early ART (difference: 7.7%; 1.3–14.1%). This effect varied over time in regression analysis and TMLE, with a higher hazard during the first year after HIV care enrolment and a similar hazard thereafter.ConclusionsCaution is needed in implementing same-day ART in routine settings.

scholarly journals The Impact of Same-Day Antiretroviral Therapy Initiation under the WHO Treat-All Policy

2021 ◽  
Author(s):  
Bernhard Kerschberger ◽  
Andrew Boulle ◽  
Rudo Kuwengwa ◽  
Iza Ciglenecki ◽  
Michael Schomaker
Keyword(s):  
Antiretroviral Therapy ◽  
Directed Acyclic Graphs ◽  
Hiv Care ◽  
People Living With Hiv ◽  
Unfavourable Outcome ◽  
Old Patients ◽  
Loss To Follow Up ◽  
Treat All ◽  
The Impact

Abstract Rapid initiation of antiretroviral therapy (ART) is recommended for people living with HIV, with the option to start treatment on the day of diagnosis (same-day-ART). However, the effect of same-day-ART remains unknown in realistic public sector settings. We established a cohort of ≥16-year-old patients who initiated first-line ART under Treat-All in Nhlangano (Eswatini) between 2014-2016, either on the day of HIV care enrolment (same-day-ART) or 1–14 days thereafter (early-ART). Directed acyclic graphs, flexible parametric survival analysis and targeted maximum likelihood estimation (TMLE) were used to estimate the effect of same-day-ART initiation on the composite unfavourable treatment outcome (loss to follow-up;death;viral failure). Of 1328 patients, 839 (63.2%) initiated same-day ART. The adjusted hazard ratio of the unfavourable outcome was increased by 1.48 (95% CI:1.16–1.89) for same-day-ART compared with early-ART. TMLE suggested that after 1 year, 28.9% of patients would experience the unfavourable outcome under same-day-ART compared with 21.2% under early-ART (difference: 7.7%; 1.3–14.1%). This estimate was driven by loss to follow-up and varied over time, with a higher hazard during the first year after HIV care enrolment and a similar hazard thereafter. We found an increased risk with same-day-ART. A limitation was possible silent transfers that were not captured.

scholarly journals Assessing the impact of HIV support groups on antiretroviral therapy adherence and viral suppression in the African cohort study

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Prudence Mbah ◽  
Michael Iroezindu ◽  
Allahna L. Esber ◽  
Nicole Dear ◽  
Domonique Reed ◽  
...  
Keyword(s):  
Cohort Study ◽  
Antiretroviral Therapy ◽  
Support Groups ◽  
Support Group ◽  
Viral Suppression ◽  
Hiv Care ◽  
People Living With Hiv ◽  
Art Adherence ◽  
African Countries ◽  
The Impact

Abstract Background Support groups for people living with HIV (PLWH) may improve HIV care adherence and outcomes. We assessed the impact of support group attendance on antiretroviral therapy (ART) adherence and viral suppression in four African countries. Methods The ongoing African Cohort Study (AFRICOS) enrolls participants at 12 clinics in Kenya, Uganda, Tanzania, and Nigeria. Self-reported attendance of any support group meetings, self-reported ART adherence, and HIV RNA are assessed every 6 months. Logistic regression models with generalized estimating equations were used to estimate adjusted odds ratios (aORs) and 95% confidence intervals (95% CIs) for support group attendance and other factors potentially associated with ART adherence and viral suppression. Results From January 2013 to December 1, 2019, 1959 ART-experienced PLWH were enrolled and 320 (16.3%) reported any support group attendance prior to enrollment. Complete ART adherence, with no missed doses in the last 30 days, was reported by 87.8% while 92.4% had viral suppression <1000copies/mL across all available visits. There was no association between support group attendance and ART adherence in unadjusted (OR 1.01, 95% CI 0.99–1.03) or adjusted analyses (aOR 1.00, 95% CI 0.98–1.02). Compared to PLWH who did not report support group attendance, those who did had similar odds of viral suppression in unadjusted (OR 0.99, 95% CI 0.978–1.01) and adjusted analyses (aOR 0.99, 95% CI 0.97–1.01). Conclusion Support group attendance was not associated with significantly improved ART adherence or viral suppression, although low support group uptake may have limited our ability to detect a statistically significant impact.

scholarly journals The Impact of Immediate Initiation of Antiretroviral Therapy on Patients' Healthcare Expenditures: A Stepped-Wedge Randomized Trial in Eswatini

2021 ◽  
Author(s):  
Janina I. Steinert ◽  
Shaukat Khan ◽  
Emma Mafara ◽  
Cebele Wong ◽  
Khudzie Mlambo ◽  
...  
Keyword(s):  
Antiretroviral Therapy ◽  
Standard Of Care ◽  
Cd4 Count ◽  
World Health ◽  
Hiv Care ◽  
People Living With Hiv ◽  
Stepped Wedge ◽  
Healthcare Expenditures ◽  
Art Initiation ◽  
Living With Hiv

AbstractImmediate initiation of antiretroviral therapy (ART) for all people living with HIV has important health benefits but implications for the economic aspects of patients' lives are still largely unknown. This stepped-wedge cluster-randomized controlled trial aimed to determine the causal impact of immediate ART initiation on patients’ healthcare expenditures in Eswatini. Fourteen healthcare facilities were randomly assigned to transition at one of seven time points from the standard of care (ART eligibility below a CD4 count threshold) to the immediate ART for all intervention (EAAA). 2261 patients living with HIV were interviewed over the study period to capture their past-year out-of-pocket healthcare expenditures. In mixed-effects regression models, we found a 49% decrease (RR 0.51, 95% CI 0.36, 0.72, p < 0.001) in past-year total healthcare expenditures in the EAAA group compared to the standard of care, and a 98% (RR 0.02, 95% CI 0.00, 0.02, p < 0.001) decrease in spending on private and traditional healthcare. Despite a higher frequency of HIV care visits for newly initiated ART patients, immediate ART initiation appears to have lowered patients’ healthcare expenditures because they sought less care from alternative healthcare providers. This study adds an important economic argument to the World Health Organization’s recommendation to abolish CD4-count-based eligibility thresholds for ART.

scholarly journals Strategies to improve the implementation of nurse-initiated management of antiretroviral therapy (NIMART) training: a systematic review

2020 ◽  
Author(s):  
Sheillah Hlamalani Mboweni ◽  
LUFUNO MAKHADO
Keyword(s):  
Systematic Review ◽  
Antiretroviral Therapy ◽  
Quality Assessment ◽  
Full Text ◽  
Positive Impact ◽  
World Health ◽  
Hiv Care ◽  
Measurement Tool ◽  
People Living With Hiv ◽  
Training Strategies

Abstract Background Nurse-Initiated Management of Antiretroviral Therapy ( NIMART) training was introduced with the purpose of improving the knowledge, skills and competence of nurses in providing comprehensive quality care to people living with HIV (PLWH) and facilitating World Health Organisation task-shifting where nurses initiate antiretroviral therapy (ART) rather than doctors to meet the increasing demand of ART drugs. The aim of this review was to identify evidence of training strategies that can improve the implementation and deals with challenges that hinder quality. Methods A measurement tool to assess systematic reviews methodological systematic review tool was used to critically assess selected studies. Studies were sought using multiple databases including CINAHL (EBSCO), Google Scholar, ProQuest, academic journals, SA publications, electronic resources and OAISTER published from January 2012 to February 2017. The initial review of studies yielded 535 results excluding duplications. The screening of full-text articles was conducted, and 33 articles met the eligibility criteria and were included for quality assessment. The rest were excluded. The quality assessment research instrument was used to analyse and synthesise selected full-text articles (n=33). Results The studies indicate that NIMART or HIV training is used interchangeably and has the potential to empower nurses with knowledge and skills. It also has a positive impact on increasing ART uptake; however, nurses still lack confidence and competence to provide comprehensive quality patient-centred care. Studies suggest that a shift from the traditional didactics of lectures or slide presentation methods during training to the use of interactive training strategies that stimulate critical thinking in making decisions about HIV care, followed by mentoring and continuous professional development. Conclusion and recommendation This study reveals that the use of effective training techniques during NIMART training has a positive impact on the learning outcomes, implementation and performance of HIV programmes. The health care system should focus on dealing with barriers that negatively influence NIMART implementation. Given the lack of a framework or model related to NIMART or HIV training, the study recommends the development of a conceptual framework to strengthens the implementation of NIMART training.

scholarly journals Incidence of Herpes Zoster in HIV-Infected Patients Undergoing Antiretroviral Therapy: A Systematic Review and Meta-analysis

2021 ◽  
Vol 10 (11) ◽  
pp. 2300
Author(s):  
Han-Chang Ku ◽  
Yi-Tseng Tsai ◽  
Sriyani-Padmalatha Konara-Mudiyanselage ◽  
Yi-Lin Wu ◽  
Tsung Yu ◽  
...  
Keyword(s):  
Systematic Review ◽  
Herpes Zoster ◽  
Antiretroviral Therapy ◽  
Random Effects ◽  
Meta Analysis ◽  
People Living With Hiv ◽  
Funnel Plots ◽  
Sex With Men ◽  
Treat All ◽  
Living With Hiv

The incidence of herpes zoster (HZ) in patients infected with HIV is higher than that of the general population. However, the incidence of HZ in HIV patients receiving antiretroviral therapy (ART) remains unclear. This meta-analysis aimed to estimate the pooled incidence rate and risk factors for HZ in the post-ART era. We identified studies assessing the incidence of HZ in the post-ART era between 1 January 2000 and 28 February 2021, from four databases. Pooled risk ratios were calculated from 11 articles using a random-effects model. The heterogeneity of the included trials was evaluated by visually inspecting funnel plots, performing random-effects meta-regression and using I2 statistics. Of the 2111 studies screened, we identified 11 studies that were eligible for final inclusion in the systematic review and 8 studies that were eligible for a meta-analysis. The pooled incidence of HZ in the post-ART era (after the introduction of ART in 1997) was 2.30 (95% confidence interval (CI): 1.56–3.05) per 100 person years (PYs). The risks of incidence of HZ among people living with HIV included male sex (AOR: 4.35 (95% CI: 054–2.41)), men who have sex with men (AOR: 1.21 (95% CI: −0.76–1.13)), CD4 count < 200 cells/μL (AOR: 11.59 (95% CI: 0.53–4.38)) and not receiving ART (AOR: 2.89 (95% CI: −0.44–2.56)). The incidence of HZ is substantially lower among HIV infected patients receiving ART than those not receiving ART. Initiating ART immediately after diagnosis to treat all HIV-positive individuals is crucial to minimize the disease burden of HZ.

Assessing antiretroviral therapy success in HIV/AIDS morbidity and mortality trends in Brazil, 1990–2017: an interrupted time series study

2020 ◽  
pp. 095646242095298
Author(s):  
Augusto Cesar Lara de Sousa ◽  
Tatiana de Araujo Eleuterio ◽  
José Victor Afonso Coutinho ◽  
Raphael Mendonça Guimarães
Keyword(s):  
Time Series ◽  
Antiretroviral Therapy ◽  
Burden Of Disease ◽  
Interrupted Time Series ◽  
People Living With Hiv ◽  
Disability Adjusted Life Years ◽  
Disability Adjusted Life ◽  
Life Years ◽  
The Impact ◽  
Hiv Aids

To describe the trends of HIV/AIDS metrics related to the burden of disease for Brazil between 1990 and 2017 we conducted a timeseries analysis for HIV/AIDS indicators by extracting data from the Global Burden of Disease study. We calculated traditional prevalence, incidence and mortality rates, the number of years lost by HIV-related deaths (YLL) and disability (YLD), and disability-adjusted life years (DALY). We estimated time series models and assessed the impact of highly active antiretroviral therapy (HAART) on the same indicators. In the set of disability-adjusted life years (DALY), the highest weight of its magnitude was due to YLL. There was a decline, especially after 1996, of DALY, mortality and YLL for HIV/AIDS. However, YLD, incidence, and prevalence increased over the same period. Also, the analysis of interrupted time series showed that the introduction of HAART into health policy had a significant impact on indicators, especially for DALY and YLL. We need to assess the quality of life of people living with HIV, especially among older adults. In addition, we need to focus on primary prevention, emphasizing methods to avoid infection and public policies should reflect this.

scholarly journals Free access to antiretroviral treatment and protection against the risk of catastrophic health expenditure in people living with HIV: evidence from Cameroon

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Marwân-al-Qays Bousmah ◽  
Marie Libérée Nishimwe ◽  
Christopher Kuaban ◽  
Sylvie Boyer
Keyword(s):  
Socioeconomic Status ◽  
Health Expenditure ◽  
Antiretroviral Treatment ◽  
Catastrophic Health Expenditure ◽  
Hiv Care ◽  
Free Access ◽  
People Living With Hiv ◽  
Art Policy ◽  
Living With Hiv ◽  
The Impact

Abstract Background To foster access to care and reduce the burden of health expenditures on people living with HIV (PLHIV), several sub-Saharan African countries, including Cameroon, have adopted a policy of removing HIV-related fees, especially for antiretroviral treatment (ART). We investigate the impact of Cameroon’s free antiretroviral treatment (ART) policy, enacted in May 2007, on catastrophic health expenditure (CHE) risk according to socioeconomic status, in PLHIV enrolled in the country’s treatment access program. Methods Based on primary data from two cross-sectional surveys of PLHIV outpatients in 2006–2007 and 2014 (i.e., before and after the policy’s implementation, respectively), we used inverse propensity score weighting to reduce covariate imbalances between participants in both surveys, combined with probit regressions of CHE incidence. The analysis included participants treated with ART in one of the 11 HIV services common to both surveys (n = 1275). Results The free ART policy was associated with a significantly lower risk of CHE only in the poorest PLHIV while no significant effect was found in lower-middle or upper socioeconomic status PLHIV. Unexpectedly, the risk of CHE was higher in those with middle socioeconomic status after the policy’s implementation. Conclusions Our findings suggest that Cameroon’s free ART policy is pro-poor. As it only benefitted PLHIV with the lowest socioeconomic status, increased comprehensive HIV care coverage is needed to substantially reduce the risk of CHE and the associated risk of impoverishment for all PLHIV.

scholarly journals The impact of an integrated depression and HIV treatment program on mental health and HIV care outcomes among people newly initiating antiretroviral therapy in Malawi

PLoS ONE ◽  
2020 ◽  
Vol 15 (5) ◽  
pp. e0231872 ◽  
Author(s):  
Melissa A. Stockton ◽  
Michael Udedi ◽  
Kazione Kulisewa ◽  
Mina C. Hosseinipour ◽  
Bradley N. Gaynes ◽  
...  
Keyword(s):  
Mental Health ◽  
Antiretroviral Therapy ◽  
Treatment Program ◽  
Hiv Treatment ◽  
Hiv Care ◽  
Care Outcomes ◽  
The Impact

scholarly journals The Impact of Delayed Switch to Second-Line Antiretroviral Therapy on Mortality, Depending on Definition of Failure Time and CD4 Count at Failure

2020 ◽  
Vol 189 (8) ◽  
pp. 811-819 ◽  
Author(s):  
Helen Bell-Gorrod ◽  
Matthew P Fox ◽  
Andrew Boulle ◽  
Hans Prozesky ◽  
Robin Wood ◽  
...  
Keyword(s):  
Antiretroviral Therapy ◽  
Failure Time ◽  
Likelihood Estimation ◽  
Cd4 Count ◽  
Second Line ◽  
Switch Time ◽  
Measured Time ◽  
Definition Of ◽  
Relationship Of ◽  
The Impact

Abstract Little is known about the functional relationship of delaying second-line treatment initiation for human immunodeficiency virus–positive patients and mortality, given a patient’s immune status. We included 7,255 patients starting antiretroviral therapy during 2004–2017, from 9 South African cohorts, with virological failure and complete baseline data. We estimated the impact of switch time on the hazard of death using inverse probability of treatment weighting of marginal structural models. The nonlinear relationship between month of switch and the 5-year survival probability, stratified by CD4 count at failure, was estimated with targeted maximum likelihood estimation. We adjusted for measured time-varying confounding by CD4 count, viral load, and visit frequency. Five-year mortality was estimated to be 10.5% (95% CI: 2.2, 18.8) for immediate switch and to be 26.6% (95% CI: 20.9, 32.3) for no switch (51.1% if CD4 count was &lt;100 cells/mm3). The hazard of death was estimated to be 0.37 (95% CI: 0.30, 0.46) times lower if everyone had been switched immediately compared with never. The shorter the delay in switching, the lower the hazard of death—delaying 30–59 days reduced the hazard by 0.53 (95% CI: 0.43, 0.65) times and 60–119 days by 0.58 (95% CI: 0.49, 0.69) times, compared with no switch. Early treatment switch is particularly important for patients with low CD4 counts at failure.

scholarly journals Rapid Antiretroviral Therapy (ART) Initiation at a Community-Based Clinic in Jackson, MS

2020 ◽  
Vol 17 (1) ◽  
Author(s):  
Courtney E. Sims Gomillia ◽  
Kandis V. Backus ◽  
James B. Brock ◽  
Sandra C. Melvin ◽  
Jason J. Parham ◽  
...  
Keyword(s):  
Viral Load ◽  
Antiretroviral Therapy ◽  
Median Time ◽  
Viral Suppression ◽  
Hiv Care ◽  
Virologic Suppression ◽  
Community Based ◽  
Art Initiation ◽  
Healthcare Center ◽  
The Impact

Abstract Background Rapid antiretroviral therapy (ART), ideally initiated within twenty-four hours of diagnosis, may be crucial in efforts to increase virologic suppression and reduce HIV transmission. Recent studies, including demonstration projects in large metropolitan areas such as Atlanta, Georgia; New Orleans, Louisiana; San Francisco, California; and Washington D.C., have demonstrated that rapid ART initiation is a novel tool for expediting viral suppression in clinical settings. Here we present an evaluation of the impact of a rapid ART initiation program in a community-based clinic in Jackson, MS. Methods We conducted a retrospective chart review of patients who were diagnosed with HIV at Open Arms Healthcare Center or were linked to the clinic for HIV care by the Mississippi State Department of Health Disease Intervention Specialists from January 1, 2016 to December 31, 2018. Initial viral load, CD4+ T cell count, issuance of an electronic prescription (e-script), subsequent viral loads until suppressed and patient demographics were collected for each individual seen in clinic during the review period. Viral suppression was defined as a viral load less than 200 copies/mL. Rapid ART initiation was defined as receiving an e-script for antiretrovirals within seven days of diagnosis. Results Between January 1, 2016 and December 31, 2018, 70 individuals were diagnosed with HIV and presented to Open Arms Healthcare Center, of which 63 (90%) completed an initial HIV counseling visit. Twenty-seven percent of patients were provided with an e-script for ART within 7 days of diagnosis. The median time to linkage to care for this sample was 12 days and 5.5 days for rapid ART starters (p < 0.001). Median time from diagnosis to viral suppression was 55 days for rapid ART starters (p = 0.03), a 22 day decrease from standard time to viral suppression. Conclusion Our results provide a similar level of evidence that rapid ART initiation is effective in decreasing time to viral suppression. Evidence from this evaluation supports the use of rapid ART initiation after an initial HIV diagnosis, including same-day treatment.

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