Readiness for Antiretroviral Therapy: Implications for Linking HIV-Infected Individuals to Care and Treatment

Maughan-Brown, Brendan; Pk, Smith; Kuo, Caroline; Harrison, Abigail; Lurie, Mark N.; Bekker, Linda‐Gail; Galárraga, Omar

doi:10.1007/s10461-017-1834-2

Cited by 19 publications

(18 citation statements)

References 55 publications

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“…Our retrospective cohort study demonstrated that patients adopting rapid ART initiation were more likely to continue engagement in care and to have a significantly lower rate of LTFU compared with those without rapid ART initiation. The discrepancies in the findings reported by our study and the aforementioned studies could be attributed to the different study settings and designs, patient populations, HIV infection status, cART accessibility, patients’ knowledge and peer experience with ART 27 28. However, the retrospective design of our study precluded us from identifying the shared decision-making process between patients and HIV care providers regarding ART initiation.…”

Section: Discussioncontrasting

confidence: 67%

Short-term outcomes of rapid initiation of antiretroviral therapy among HIV-positive patients: real-world experience from a single-centre retrospective cohort in Taiwan

et al. 2019

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ObjectivesRapid initiation of antiretroviral therapy (ART) engenders faster viral suppression but with suboptimal rates of durable viral suppression and engagement in care, as reported by clinical trials in resource-limited settings. Real-world experience with rapid ART initiation remains limited in resource-rich settings.DesignRetrospective cohort study.SettingA tertiary hospital in metropolitan Taipei, Taiwan.ParticipantsWe included 631 patients newly diagnosed as having HIV infection between March 2014 and July 2018.Main outcome measuresRapid ART initiation was defined as starting ART within 7 days after HIV diagnosis confirmation. HIV diagnosis, ART initiation and viral suppression dates and clinical outcome data were collected by reviewing medical records. The rates of loss to follow-up (LTFU), engagement in care and virological rebound at 12 months were compared between patients with rapid ART initiation and those with standard initiation.ResultsRapid ART initiation increased from 33.8% in 2014 to 68.3% in 2017, and the median interval between HIV diagnosis and viral suppression (HIV RNA load <200 copies/mL) decreased from 138 to 47 days. Patients with rapid ART initiation had a significantly higher rate of engagement in care at 12 months than did those with standard initiation (88.3% vs 79.0%; p=0.002). Patients aged <30 years had a higher risk of LTFU (HR: 2.19; 95% CI 1.20 to 3.98); and rapid ART initiation was associated with a lower risk of LTFU (HR: 0.41; 95% CI 0.24 to 0.83). Patients aged <30 years were more likely to acquire incident sexually transmitted infections (STIs) before achieving viral suppression.ConclusionsRapid ART initiation was associated with a higher rate of engagement in care at 12 months and shortened interval from diagnosis to HIV suppression. Delayed ART initiation may increase onwards HIV transmission considering the high rates of STIs.Ethics approvalThe study was approved by the Research Ethics Committee of National Taiwan University Hospital (Registration No. 201003112R).

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Section: Discussioncontrasting

confidence: 67%

Short-term outcomes of rapid initiation of antiretroviral therapy among HIV-positive patients: real-world experience from a single-centre retrospective cohort in Taiwan

et al. 2019

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“…We minimized the risk of coercion to start ART rapidly by deliberately setting out the potential disadvantages and benefits of early ART at the first medical appointment and, indeed, a quarter of patients declined to start at this appointment, suggesting that our anxiety was misplaced. There has been debate about the readiness of patients with newly diagnosed HIV infection to rapidly initiate ART and whether this may indeed impair long‐term retention in care, although other data suggest that this is not the case . Commenting further is beyond the scope of this report and requires longer follow‐up of bigger cohorts.…”

Section: Discussionmentioning

confidence: 92%

Rapid initiation of antiretroviral therapy in those with newly diagnosed HIV infection in London, UK

et al. 2019

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Objectives In July 2016, as a result of patient demand, we introduced a rapid initiation option (RIO) to offer a first medical appointment and antiretroviral therapy (ART) initiation within 2 days of HIV diagnosis at 56 Dean Street (56DS) , a combined sexual health and HIV treatment service in London, UK. Methods We performed a retrospective case‐note review of patients newly diagnosed with HIV infection at 56DS following the introduction of the new RIO from July to October 2016. In order to assess the effect of the new service on ART uptake, we chose a comparison group of newly diagnosed patients at 56DS from 1 year earlier: July to October 2015. Results In the 4 months following RIO introduction, there was a reduction in the median time from HIV diagnosis to the first medical appointment (7 versus 15 days; P < 0.00001) and to ART initiation (8 versus 21 days; P < 0.00001) compared with the same 4‐month period 1 year previously. Uptake of ART at first appointment also significantly increased from 60% to 76% (P = 0.0074). Conclusions By increasing our clinic capacity and awareness of staff and patients of the RIO service, we were able to fulfil the aim of the service to offer ART more quickly following HIV diagnosis.

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“…There is a need to understand the relatively low levels of ART coverage given the changes in treatment guidelines to UTT in 2016. Previous studies found that being diagnosed with HIV does not necessarily translate to universal uptake of ART even though one is offered treatment [10,11,16]. It is not clear what the scale of treatment refusal among PLHIV is.…”

Section: Discussionmentioning

confidence: 99%

Towards achieving the 90–90–90 HIV targets: results from the south African 2017 national HIV survey

et al. 2020

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Background Measuring progress towards the Joint United Nations Programme on HIV/AIDS (UNAIDS) 90–90–90 treatment targets is key to assessing progress towards turning the HIV epidemic tide. In 2017, the UNAIDS model estimated that 75% of people living with HIV (PLHIV) globally knew their HIV positive status, 79% of those who knew their status were on antiretroviral therapy (ART), and 81% of those who knew their HIV status and were on ART had a suppressed viral load. The fifth South African national HIV sero-behavioural survey collected nationally representative data that enabled the empirical estimation of these 90–90–90 targets for the country stratified by a variety of key factors. Methods To evaluate progress towards achievement of the 90–90–90 targets for South Africa, data obtained from a national, representative, cross-sectional population-based multi-stage stratified cluster random survey conducted in 2017 were analysed. The Fifth South African National HIV Prevalence, Incidence, Behaviour and Communication Survey (SABSSM V), collected behavioural and biomarker data from individuals residing in households from 1000 randomly selected Small Area Layers (SALs), across all nine provinces of the country. Structured questionnaires were used to collect socio-demographic data, knowledge and perceptions about HIV, and related risk behaviours. Blood samples were collected to test for HIV infection, antiretroviral use, and viral suppression (defined as < 1000 copies/ml). Weighted proportions of study participants aged 15 years and older who tested HIV positive were computed for those who reported awareness of their status (1st 90), and among these, those who were currently on ART (2nd 90) and of these, those who were virally suppressed (3rd 90). Results Among persons 15 years and older who were HIV positive, 84.8% were aware of their HIV positive status, of whom 70.7% were currently on ART, with 87.4% of these estimated to have suppressed viral load at the time of the survey. These estimates varied by sex, age, and geo-location type. Relatively higher percentages across all three indicators for women compared to men were observed: 88.7% versus 78.2% for those aware of their status, 72.3% versus 67.7% for on ART, and 89.8% versus 82.3% for viral suppression. Knowing one’s positive HIV status increased with age: 74.0, 85.8, and 88.1% for age groups 15–24 years old, 25–49 years old and 50–64 years old, although for those 65 years and older, 78.7% knew their HIV positive status. A similar pattern was observed for the 2nd 90, among those who knew their HIV positive status, 51.7% of 15 to 24 year olds, 70.5% of those aged 25–49 years old, 82.9% of those aged 50–64 years old and 82.4% of those aged 65 years or older were currently on ART. Viral suppression for the above mentioned aged groups, among those who were on ART was 85.2, 87.2, 89.5, and 84.6% respectively. The 90–90–90 indicators for urban areas were 87.7, 66.5, and 87.2%, for rural settings was 85.8, 79.8, and 88.4%, while in commercial farming communities it was 56.2, 67.6 and 81.4%. Conclusions South Africa appears to be on track to achieve the first 90 indicator by 2020. However, it is behind on the second 90 indicator with ART coverage that was ~ 20-percentage points below the target among people who knew their HIV status, this indicates deficiencies around linkage to and retention on ART. Overall viral suppression among those on ART is approaching the target at 87.4%, but this must be interpreted in the context of low reported ART coverage as well as with variation by age and sex. Targeted diagnosis, awareness, and treatment programs for men, young people aged 15–24 years old, people who reside in farming communities, and in specific provinces are needed. More nuanced 90–90–90 estimates within provinces, specifically looking at more granular sub-national level (e.g. districts), are needed to identify gaps in specific regions and to inform provincial interventions.

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Readiness for Antiretroviral Therapy: Implications for Linking HIV-Infected Individuals to Care and Treatment

Cited by 19 publications

References 55 publications

Short-term outcomes of rapid initiation of antiretroviral therapy among HIV-positive patients: real-world experience from a single-centre retrospective cohort in Taiwan

Short-term outcomes of rapid initiation of antiretroviral therapy among HIV-positive patients: real-world experience from a single-centre retrospective cohort in Taiwan

Rapid initiation of antiretroviral therapy in those with newly diagnosed HIV infection in London, UK

Towards achieving the 90–90–90 HIV targets: results from the south African 2017 national HIV survey

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