Multidisciplinary Point-of-Care Testing in South African Primary Health Care Clinics Accelerates HIV ART Initiation but Does Not Alter Retention in Care

Stevens, Wendy; Gous, Natasha; Macleod, W. Bentley; Long, Lawrence; Variava, Ebrahim; Martinson, Neil; Sanne, Ian; Osih, Regina; Scott, Lesley

doi:10.1097/qai.0000000000001456

Cited by 27 publications

(47 citation statements)

References 23 publications

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“…Six studies prespecified the outcomes measured in published protocols. We did not find prespecified outcomes for Stevens 2017, but they reported all relevant and non‐significant outcomes.…”

Section: Resultsmentioning

confidence: 94%

“…CD4 threshold to determine eligibility of ART differed across studies. In Elul 2017, McNairy 2017, Rosen 2016, and Stevens 2017, participants were eligible for ART if their CD4 count was less than 350 cells/mm 3 . Amanyire 2016 and Koenig 2017 started with the same threshold (350 cells/mm 3 ) but, following changes in national guidelines, changed the ART eligibility criteria during the study to include all participants with CD4 count fewer than 500 cells/mm 3 .…”

Section: Resultsmentioning

confidence: 99%

“…One study also described expediting tuberculosis (TB) screening before they offered ART (Rosen 2016). In Amanyire 2016, Rosen 2016, and Stevens 2017, healthcare workers received training on the new procedures and instruments implemented (for example, POC instruments) before rapid ART was delivered.…”

Section: Resultsmentioning

confidence: 99%

“…One study, Stevens 2017, did not describe allocation concealment methods; we therefore judged it as unclear risk of bias in this domain.…”

Section: Resultsmentioning

confidence: 99%

“…Three studies gave no information about blinding of outcome assessors (Amanyire 2016; Labhardt 2018; Stevens 2017), and one study reported that statisticians were not blinded (Koenig 2017). …”

Section: Resultsmentioning

confidence: 99%

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Rapid initiation of antiretroviral therapy for people living with HIV

Urdiales

Johnson

Smith

et al. 2019

Cochrane Database of Systematic Reviews

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Background Despite antiretroviral therapy (ART) being widely available, HIV continues to cause substantial illness and premature death in low‐and‐middle‐income countries. High rates of loss to follow‐up after HIV diagnosis can delay people starting ART. Starting ART within seven days of HIV diagnosis (rapid ART initiation) could reduce loss to follow‐up, improve virological suppression rates, and reduce mortality. Objectives To assess the effects of interventions for rapid initiation of ART (defined as offering ART within seven days of HIV diagnosis) on treatment outcomes and mortality in people living with HIV. We also aimed to describe the characteristics of rapid ART interventions used in the included studies. Search methods We searched CENTRAL, the Cochrane Database of Systematic Reviews, MEDLINE, Embase, and four other databases up to 14 August 2018. There was no restriction on date, language, or publication status. We also searched ClinicalTrials.gov and the World Health Organization (WHO) International Clinical Trials Registry Platform, and websites for unpublished literature, including conference abstracts. Selection criteria We included randomized controlled trials (RCTs) that compared rapid ART versus standard care in people living with HIV. Children, adults, and adolescents from any setting were eligible for inclusion. Data collection and analysis Two review authors independently assessed the eligibility of the studies identified in the search, assessed the risk of bias and extracted data. The primary outcomes were mortality and virological suppression at 12 months. We have presented all outcomes using risk ratios (RR), with 95% confidence intervals (CIs). Where appropriate, we pooled the results in meta‐analysis. We assessed the certainty of the evidence using the GRADE approach. Main results We included seven studies with 18,011 participants in the review. All studies were carried out in low‐ and middle‐income countries in adults aged 18 years old or older. Only one study included pregnant women. In all the studies, the rapid ART intervention was offered as part of a package that included several cointerventions targeting individuals, health workers and health system processes delivered alongside rapid ART that aimed to facilitate uptake and adherence to ART. Comparing rapid ART with standard initiation probably results in greater viral suppression at 12 months (RR 1.18, 95% CI 1.10 to 1.27; 2719 participants, 4 studies; moderate‐certainty evidence) and better ART uptake at 12 months (RR 1.09, 95% CI 1.06 to 1.12; 3713 participants, 4 studies; moderate‐certainty evidence), and may improve retention in care at 12 months (RR 1.22, 95% CI 1.11 to 1.35; 5001 participants, 6 studies; low‐certainty evidence). Rapid ART initiation was associated with a lower mortality estimate, however the CIs included n...

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Section: Resultsmentioning

confidence: 94%