Effects of the implementation of the HIV Treat All guidelines on key ART treatment outcomes in Namibia

Abstract

Background This study aimed to help the Namibian government understand the impact of Treat All implementation (started on April 1, 2017) on key antiretroviral therapy (ART) outcomes, and how this transition impacts progress toward the UNAIDS’s 90-90-90 HIV targets. Methods We collected clinical records from two separate cohorts (before and after treat-all) of ART patients in 10 high- and medium-volume facilities in 6 northern Namibia districts. Each cohort contains 12-month data on patients’ scheduled appointments and visits, health status, and viral load results. We also measured patients’ wait time and perceptions of service quality using exit interviews with 300 randomly selected patients (per round). We compared ART outcomes of the two cohorts: ART initiation within 7 days from diagnosis, loss to follow-up (LTFU), missed scheduled appointments for at least 30 days, and viral suppression using unadjusted and adjusted analyses. Results Among new ART clients (on ART for less than 3 months or had not yet initiated treatment as of the start date for the ART record review period), rapid ART initiation (within 7 days from diagnosis) was 5.2 times higher after Treat All than that among clients assessed before the policy took effect [AOR: 5.2 (3.8–6.9)]. However, LTFU was higher after Treat All roll-out compared to before Treat All [AOR: 1.9 (1.3–2.8)]. Established ART clients (on ART treatment for at least three months at the start date of the ART record review period) had over 3 times greater odds of achieving viral suppression after Treat All roll-out compared to established ART clients assessed before Treat All [AOR: 3.1 (1.6–5.9)]. Conclusions and recommendations The findings indicate positive effect of the “Treat All” implementation on ART initiation and viral suppression, and negative effect on LTFU. Additionally, by April 2018, Namibia seems to have reached the UNAIDS’s 90-90-90 targets.

Rapid antiretroviral therapy initiation and its effect on treatment response in MSM in West Africa

“…Almost all participants (95.7%) initiated ART after a median time of 5 days, which is consistent with recent data reported in Namibia [ 32 ]. In addition to the clinical benefits for the patients themselves, this is a very positive result for HIV transmission prevention [ 4 , 33 , 34 ], given that the participants reported frequent anal sexual intercourse with men, and frequent condomless anal intercourse.…”

Timely initiation of HIV antiretroviral therapy in Haiti 2004–2018: a retrospective cohort study

“…Haiti’s level of same-day ART after T&S policy adoption (45.0%) compared favorably to the level found in a global survey of ART access in LMICs (38.4%) ( 14 ) but was lower than that observed in Botswana, Kenya, and Malawi (57.1%, 63.6%, and 69.5%) ( 15 , 16 ). The trend toward early HIV diagnosis and rapid ART for those with WHO stage 1 and 2, following adoption of T&S in Haiti, was similar to the trend documented in Namibia following policy change ( 17 ).…”

Engagement in HIV continuum of care: Another step needed to close the gap toward UNAIDS 90‐90‐90 targets among younger men in Rwanda

“…Other studies have consistently reported lower VLS among men in Rwanda 6,18,19 . In Namibia, although the country achieved the 90‐90‐90 targets by 2020, lower VLS among men delayed achievement of these targets 20–22 . Men, in general have been reportd to have lower uptake of HIV services.…”

“…6,18,19 In Namibia, although the country achieved the 90-90-90 targets by 2020, lower VLS among men delayed achievement of these targets. [20][21][22] Men, in general have been reportd to have lower uptake of HIV services. This pattern is also observed in key hard-to-reach groups among men, for example, men who have sex with men (MSM).…”