Effect of Offering Same-Day ART vs Usual Health Facility Referral During Home-Based HIV Testing on Linkage to Care and Viral Suppression Among Adults With HIV in Lesotho

Labhardt, Niklaus Daniel; Ringera, Isaac; Lejone, Thabo Ishmael; Klimkait, Thomas; Muhairwe, Josephine; Amstutz, Alain; Glass, Tracy R.

doi:10.1001/jama.2018.1818

Cited by 220 publications

(284 citation statements)

References 17 publications

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“…5–7 In 1 study, individuals were randomized to early ART with simplified counseling and point-of-care CD4 cell assays or to standard care. In the intervention group, 80% began ART within 14 days and 71% started ART the same day of eligibility, compared with 38% and 18%, respectively, in the control group.…”

Section: When To Startmentioning

confidence: 99%

Antiretroviral Drugs for Treatment and Prevention of HIV Infection in Adults

Saag

Benson

Gandhi

et al. 2018

JAMA

501

287

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IMPORTANCE Antiretroviral therapy (ART) is the cornerstone of prevention and management of HIV infection. OBJECTIVE To evaluate new data and treatments and incorporate this information into updated recommendations for initiating therapy, monitoring individuals starting therapy, changing regimens, and preventing HIV infection for individuals at risk. EVIDENCE REVIEW New evidence collected since the International Antiviral Society–USA 2016 recommendations via monthly PubMed and EMBASE literature searches up to April 2018; data presented at peer-reviewed scientific conferences. A volunteer panel of experts in HIV research and patient care considered these data and updated previous recommendations. FINDINGS ART is recommended for virtually all HIV-infected individuals, as soon as possible after HIV diagnosis. Immediate initiation (eg, rapid start), if clinically appropriate, requires adequate staffing, specialized services, and careful selection of medical therapy. An integrase strand transfer inhibitor (InSTI) plus 2 nucleoside reverse transcriptase inhibitors (NRTIs) is generally recommended for initial therapy, with unique patient circumstances (eg, concomitant diseases and conditions, potential for pregnancy, cost) guiding the treatment choice. CD4 cell count, HIV RNA level, genotype, and other laboratory tests for general health and co-infections are recommended at specified points before and during ART. If a regimen switch is indicated, treatment history, tolerability, adherence, and drug resistance history should first be assessed; 2 or 3 active drugs are recommended for a new regimen. HIV testing is recommended at least once for anyone who has ever been sexually active and more often for individuals at ongoing risk for infection. Preexposure prophylaxis with tenofovir disoproxil fumarate/emtricitabine and appropriate monitoring is recommended for individuals at risk for HIV. CONCLUSIONS AND RELEVANCE Advances in HIV prevention and treatment with antiretroviral drugs continue to improve clinical management and outcomes for individuals at risk for and living with HIV.

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Section: When To Startmentioning

confidence: 99%

Antiretroviral Drugs for Treatment and Prevention of HIV Infection in Adults

Saag

Benson

Gandhi

et al. 2018

JAMA

501

287

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“…In LMICs, benefits of rapid-start ART vs. standard care include higher rates of linkage to care at 3 (68.6% vs. 43.1%) and 12 months (56% vs. 43%; P = 0.03) [7]; shorter (by 3 months) time to viral suppression [9]; substantial (26%) increase in the absolute number of people achieving viral suppression [8]; higher rates of HIV suppression at 12 months (50.4% vs 34.3%) [7]; 36% increase in ART uptake [8]; and significantly better outcomes [7], including rates of severe illness [6], adverse events or death [18]. Fig.…”

Section: Rapid Art In Lmicsmentioning

confidence: 99%

“…Rapid-start ART has been adopted by several programmes in low-and middle-income countries (LMICs) [4][5][6][7][8], and some in high-income countries (HICs) [9][10][11][12]. Robust evidence demonstrates the benefits of rapid-start strategies, especially in LMIC settings with high prevalence of HIV infection, late presentation and limited access to care [3][4][5][6][7][8]13]. However, good-quality evidence is lacking regarding the optimum timing, format and relative value of rapid initiation interventions in HICs.…”

Section: Introductionmentioning

confidence: 99%

Rapid initiation of antiretroviral therapy at HIV diagnosis: definition, process, knowledge gaps

et al. 2019

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Initiating antiretroviral therapy (ART) as early as the day of HIV diagnosis is a strategy of increasing global interest to control the HIV epidemic and optimize the health of people living with HIV (PLWH). No detrimental effects of rapid‐start ART have been identified in randomized controlled trials undertaken in low‐ or middle‐income countries, or in cohort studies performed in high‐income countries. Rapid‐start ART may be a key approach in reaching the 2020 Joint United Nations Programme on HIV/AIDS goal of 90% of all PLWH knowing their status, 90% of those diagnosed receiving sustained ART, and 90% of those receiving ART achieving viral suppression; it may also be important for achieving the suggested fourth “90%” goal: improving health‐related quality‐of‐life in PLWH. Presently there is insufficient broad evidence for guidelines to recommend universal test‐and‐treat strategies for all people, in all settings, at HIV diagnosis; consequently, there is a pressing need to conduct high‐quality studies that investigate immediate ART initiation. This article evaluates global evidence regarding rapid‐start ART, including same‐day start, with particular focus on the implementation of this strategy in high‐income countries.

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“…However, in contrast to prior research, we found high levels of “ART denial” – in the form of a low sensitivity of ART use, suggesting that SR-ART may not be a sufficient way to identify individuals who are not yet in ART care and require ART linkage. While interventions to promote linkage to ART programs after home-based testing based on SR-ART offer large potential benefits to PLWH who are not on ART, 5 our finding suggest that such interventions might also unnecessarily divert resources to those already in care due to “ART denial.” This phenomenon could also result in underestimates of ART coverage during efforts to monitor and evaluate progress toward international treatment targets.…”

Section: Discussionmentioning

confidence: 80%

“…6 This anticipated model of care will include delivery of HIV prevention, testing, linkage to care and even distribution of antiretroviral therapy by CHWs. 5,7 As these tasks shift from clinics to home-based care delivery, simple, low-cost methods of identifying those most in need of HIV services will be needed. As such, self-reported use of antiretroviral therapy (SR-ART) in the home setting is a potentially important entry point for CHWs to provide services to improve ART retention, adherence, and outcomes.…”

Section: Introductionmentioning

confidence: 99%

ART Denial: Results of a Home-Based Study to Validate Self-reported Antiretroviral Use in Rural South Africa

et al. 2018

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OBJECTIVE: There is increasing interest in home based testing and treatment of HIV to expand access to treatment in sub-Saharan Africa. Such programs rely on self-reported HIV history and use of antiretroviral therapy (ART). However, the accuracy of self-reported ART use in community settings is not well described. In this study, we compared self-reported ART (SR-ART) use in a home based survey against biological exposure to ART (BE-ART), in a population study of older adults in South Africa. METHODS: Health and Aging in Africa: a Longitudinal Study of an INDEPTH community in South Africa (HAALSI) is a cohort of adults aged 40+. The baseline home-based interview included self-reported HIV status and ART use. All participants also underwent biological testing for HIV antibodies, viral load and exposure to emtricitabine (FTC) or lamivudine (3TC), which are included in all first-line and second-line ART regimens in the public-sector South African HIV program. We calculated the performance characteristics for SR-ART compared to BE-ART and fit multivariable logistic regression models to identify correlates of invalid SR-ART responses. RESULTS: Of 4,560 HAALSI participants with a valid HIV test result available, 1,048 (23%) were HIV-positive and 734 [70% of people living with HIV (PLWH)] were biologically validated ART users (BE-ART). The sensitivity of SR-ART use was 64% (95% CI: 61–68%) and the specificity was 94% (95% CI: 91–96%); the positive predictive value (PPV) was 96% (95% CI: 94–98%) and negative predictive value (NPV) was 52% (95% CI: 48–56%). We found no sociodemographic predictors of accurate SR-ART use. CONCLUSIONS: Over one in three individuals with detectable ART in their blood denied current ART use during a home-based interview. These results demonstrate ongoing stigma related to HIV and its treatment, and have important implications for community health worker programs, clinical programs, and research studies planning community-based ART initiation in the region.

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Effect of Offering Same-Day ART vs Usual Health Facility Referral During Home-Based HIV Testing on Linkage to Care and Viral Suppression Among Adults With HIV in Lesotho

Abstract: clinicaltrials.gov Identifier: NCT02692027.

Cited by 220 publications

References 17 publications

Antiretroviral Drugs for Treatment and Prevention of HIV Infection in Adults

Antiretroviral Drugs for Treatment and Prevention of HIV Infection in Adults

Rapid initiation of antiretroviral therapy at HIV diagnosis: definition, process, knowledge gaps

ART Denial: Results of a Home-Based Study to Validate Self-reported Antiretroviral Use in Rural South Africa

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