Impact of "test and treat" recommendations on eligibility for antiretroviral treatment: Cross sectional population survey data from three high HIV prevalence countries

Abstract

BackgroundLatest WHO guidelines recommend starting HIV-positive individuals on antiretroviral therapy treatment (ART) regardless of CD4 count. We assessed additional impact of adopting new WHO guidelines.MethodsWe used data of individuals aged 15–59 years from three HIV population surveys conducted in 2012 (Kenya) and 2013 (Malawi and South Africa). Individuals were interviewed at home followed by rapid HIV and CD4 testing if tested HIV-positive. HIV-positive individuals were classified as “eligible for ART” if (i) had ever been initiated on ART or (ii) were not yet on ART but met the criteria for starting ART based on country’s guidelines at the time of the survey (Kenya–CD4< = 350 cells/μl and WHO Stage 3 or 4 disease, Malawi as for Kenya plus lifelong ART for all pregnant and breastfeeding women, South Africa as for Kenya plus ART for pregnant and breastfeeding women until cessation of breastfeeding).FindingsOf 18,991 individuals who tested, 4,113 (21.7%) were HIV-positive. Using country’s ART eligibility guidelines at the time of the survey, the proportion of HIV-infected individuals eligible for ART was 60.0% (95% CI: 57.2–62.7) (Kenya), 73.4% (70.8–75.8) (South Africa) and 80.1% (77.3–82.6) (Malawi). Applying WHO 2013 guidelines (eligibility at CD4< = 500 and Option B+ for pregnant and breastfeeding women), the proportions eligible were 82.0% (79.8–84.1) (Kenya), 83.7% (81.5–85.6) (South Africa) and 87.6% (85.0–89.8) (Malawi). Adopting “test and treat” would mean a further 18.0% HIV-positive individuals (Kenya), 16.3% (South Africa) and 12.4% (Malawi) would become eligible. In all countries, about 20% of adolescents (aged 15–19 years), became eligible for ART moving from WHO 2013 to “test and treat” while no differences by sex were observed.ConclusionCountries that have already implemented 2013 WHO recommendations, the burden of implementing “test and treat” would be small. Youth friendly programmes to help adolescents access and adhere to treatment will be needed.

Assessing the validity of and factors that influence accurate self-reporting of HIV status after testing: a population-based study

“…As such, the observed higher sensitivity during 2011–2012 than in 2007–2010 are expected. The 2013–2018 period saw major changes in national HIV/ART guidelines including expansion of Option B+ [ 18 , 19 ] to all antenatal care clinics in Malawi in 2013 [ 20 , 21 ], and adoption of the 2015 WHO guidelines [ 22 ] on universal ‘test and treat’ in 2016 [ 23 – 25 ]. It might be expected that more people would be aware of their HIV status during this period resulting in higher sensitivity for HIV status.…”

Distribution of advanced HIV disease from three high HIV prevalence settings in Sub-Saharan Africa: a secondary analysis data from three population-based cross-sectional surveys in Eshowe (South Africa), Ndhiwa (Kenya) and Chiradzulu (Malawi)

“…For minors younger than 18 years, parental/guardian consent was sought first in Ndhiwa (Kenya) and Eshowe (South Africa) but was not required in Chiradzulu (Malawi) where minors aged 14-17 years old are considered able to give their own consent for HIV testing. Details of HIV rapid testing methods and other laboratory tests carried out including testing materials have been reported in more detail elsewhere [20]. Data were double entered using EpiData and checked for inconsistencies before analysis.…”

“…Detailed description of the demographic characteristics of the study population has been reported elsewhere [20]. For this analysis, we compared the characteristics of PLHIV with and without advanced HIV disease using chi-square tests.…”

Patient-mix, programmatic characteristics, retention and predictors of attrition among patients starting antiretroviral therapy (ART) before and after the implementation of HIV “Treat All” in Zimbabwe

“…To date, studies on whether HIV "Treat All" has improved ART initiation among adolescents are inconclusive. Positive effects have been shown in some studies, while others have shown that they are still at risk of not initiating ART [23,[27][28][29]. To our knowledge, no evidence-based strategies are currently being implemented in Zimbabwe on a broader scale under "Treat All" to promote ART initiation among adolescents and young adults.…”