Longitudinal analysis of sociodemographic, clinical and therapeutic factors of HIV-infected individuals in Kinshasa at antiretroviral therapy initiation during 2006-2017

Abstract

Background The benefits of antiretroviral therapy (ART) underpin the recommendations for the early detection of HIV infection and ART initiation. Late initiation (LI) of antiretroviral therapy compromises the benefits of ART both individually and in the community. Indeed, it promotes the transmission of infection and higher HIV-related morbidity and mortality with complicated and costly clinical management. This study aims to analyze the evolutionary trends in the median CD4 count, the median time to initiation of ART, the proportion of patients with advanced HIV disease at the initiation of ART between 2006 and 2017 and their factors. Methods and findings HIV-positive adults (≥ 16 years old) who initiated ART between January 1, 2006 and December 31, 2017 in 25 HIV care facilities in Kinshasa, the capital of DRC, were eligible. The data were processed anonymously. LI is defined as CD4≤350 cells/μl and/or WHO clinical stage III or IV and advanced HIV disease (AHD), as CD4≤200 cells/μl and/or stage WHO clinic IV. Factors associated with advanced HIV disease at ART initiation were analyzed, irrespective of year of enrollment in HIV care, using logistic regression models. A total of 7278 patients (55% admitted after 2013) with an average age of 40.9 years were included. The majority were composed of women (71%), highly educated women (68%) and married or widowed women (61%). The median CD4 was 213 cells/μl, 76.7% of patients had CD4≤350 cells/μl, 46.1% had CD4≤200 cells/μl, and 59% of patients were at WHO clinical stages 3 or 4. Men had a more advanced clinical stage (p <0.046) and immunosuppression (p<0.0007) than women. Overall, 70% of patients started ART late, and 25% had AHD. Between 2006 and 2017, the median CD4 count increased from 190 cells/μl to 331 cells/μl (p<0.0001), and the proportions of patients with LI and AHD decreased from 76% to 47% (p< 0.0001) and from 18.7% to 8.9% (p<0.0001), respectively. The median time to initiation of ART after screening for HIV infection decreased from 40 to zero months (p<0.0001), and the proportion of time to initiation of ART in the month increased from 39 to 93.3% (p<0.0001) in the same period. The probability of LI of ART was higher in married couples (OR: 1.7; 95% CI: 1.3–2.3) (p<0.0007) and lower in patients with higher education (OR: 0.74; 95% CI: 0.64–0.86) (p<0.0001). Conclusion Despite increasingly rapid treatment, the proportions of LI and AHD remain high. New approaches to early detection, the first condition for early ART and a key to ending the HIV epidemic, such as home and work HIV testing, HIV self-testing and screening at the point of service, must be implemented.

Factors influencing rapid antiretroviral therapy initiation in Jiulongpo, Chongqing, China: a retrospective cohort from 2018 to 2022

“…In metropolitan Taipei, Taiwan, rapid ART initiation reached 68.3% in 2017 [ 27 ], while same-day initiation (SDI) achieved a rate of 69.2% in KwaZulu Natal, South Africa, in 2020 [ 28 ]. Following the implementation of the “treat all” policy, there has been a noticeable trend towards a reduction in the median time to ART initiation post-HIV infection screening [ 29 ]. However, in Jiulongpo, Chongqing, the rate of rapid treatment initiation still requires enhancement through various strategies.…”

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“…7 Published data showed varying differences in changes in the proportion of advanced HIV disease among people presenting for care at clinics in South Africa with some little or no change 8 , 9 while others reported substantial decline over the years. 10 - 12 A larger proportion of people with advanced HIV are ART experienced 2 suggesting that the majority of these seek care late when their health has already deteriorated although the proportion of late presenters and those initiating ART with advanced HIV is slowly decreasing 11 , 13 with mixed results in others. 12 …”

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“…To improve access to ART and follow the World Health Organization (WHO) recommendations, the Democratic Republic of Congo (DRC) has adopted the “test and treat” (T&T) strategy since November 2016 [ 4 , 5 ]. In addition, to improve treatment monitoring in LMICs, the WHO has recommended viral load (VL) testing as the preferred strategy for monitoring the effectiveness of ART, leading to progressive phasing out of baseline CD4 T-cell count testing [ 6 , 7 ].…”