Regression discontinuity analysis demonstrated varied effect of Treat-All on CD4 testing among Southern African countries

Zaniewski, Elizabeth; Brazier, Ellen; Ostinelli, Cam Ha Dao; Wood, Robin; Osler, Meg; Technau, Karl-Günter; Oosterhout, Joep J. van; Maxwell, Nicola; Dijk, Janneke van; Prozesky, Hans; Fox, Matthew P.; Bor, Jacob; Nash, Denis; Egger, Matthias

doi:10.1016/j.jclinepi.2021.09.001

Cited by 3 publications

(8 citation statements)

References 30 publications

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“…The recommendation did not prevent people with advanced HIV disease from initiating ART (6,7). However, one study found that the "Treat all" guidelines may have reduced pre-ART CD4 monitoring, weakening advanced HIV disease management (8). One reason for our findings is that several countries began their cervical cancer prevention programmes around 2008, with government support, followed by a rapid scale-up.…”

Section: Discussionmentioning

confidence: 77%

“…Our result supports the evidence that shows that the recommendations often have heterogeneous impacts on objectives. The guidelines sometimes have unintended consequences (6,7,8,16,17,18). In the United States of America (USA), state insurance mandates to cover costs for Pap smear tests, increased Pap testing rates by 1.3 percentage points among women aged 19_64.…”

Section: Discussionmentioning

confidence: 99%

“…The recommendation did not prevent people with advanced HIV disease from initiating ART (6,7). However, one study found that the “Treat all” guidelines may have reduced pre-ART CD4 monitoring, weakening advanced HIV disease management (8).…”

Section: Discussionmentioning

confidence: 99%

“…Studies have examined the policy-level impacts of the WHO guidelines to expand the HIV treatment eligibility criteria and the “Treat all” guidelines to provide immediate anti-retroviral therapy (ART) to people living with HIV (PLHIV) regardless of their CD4 count (6,7,8). These studies found that the guidelines expanded the enrolment and retention of PLHIV in care (6,7,8). Research is required to identify whether the 2013 WHO cervical pre-cancer guidelines changed dynamics around screening for vulnerable women in east and southern Africa.…”

Section: Introductionmentioning

confidence: 99%

“…However, the impact of the 2013 WHO cervical pre-cancer screening and treatment guidelines and the age to start screening at the population level has not been studied. Studies have examined the policy-level impacts of the WHO guidelines to expand the HIV treatment eligibility criteria and the "Treat all" guidelines to provide immediate anti-retroviral therapy (ART) to people living with HIV (PLHIV) regardless of their CD4 count (6,7,8). These studies found that the guidelines expanded the enrolment and retention of PLHIV in care (6,7,8).…”

Section: Introductionmentioning

confidence: 99%

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Impact of the 2013 WHO guidelines for screening and treatment of cervical precancerous lesions on women’s screening rates, by HIV-status, in East and Southern Africa: A regression discontinuity design analysis

Chipanta,

Osborne,

Bohlius

et al. 2024

Preprint

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Introduction: In 2013, the World Health Organization (WHO) issued guidelines for cervical pre-cancer screening. It recommended screening women aged 30-49, and younger women once they tested HIV-positive. Subsequent WHO guidelines recommended screening women living with HIV (WLHIV) starting at age 25. However, the impact of 2013 guidelines and age to start screening on screening has not been studied. Methods: We used a regression discontinuity design (RDD) analysis of population-based data to assess the impact of the 2013 WHO guidelines on the screening rates for women according to HIV status and age group in Ethiopia, Malawi, Rwanda, Tanzania, Zambia, and Zimbabwe. The outcome was self-reported ever having been screened for cervical pre-cancer between 2008 and 2018. We compared the screening rates according to HIV status and age group, before and after age 25 years. And before and after 2014, the year countries adopted the 2013 guidelines. We then used a data-driven optimal bandwidth selection procedure to estimate the guidelines average treatment effect (ATE), with a local polynomial regression discontinuity and robust bias-corrected confidence intervals. We validated the RDD methodology overall and for women with a significant ATE at the country-level analysis. Results: We included 73179 women: 6680 (9.1%) living with HIV, 4328 (5.9%) with unknown HIV status, and 62171 (85.0) with a negative HIV status. 5726 (7.9%) reported having ever been screened; 4022 (6.5%) with unknown HIV status, 525 (12.1%) with a negative HIV status and 1179 (17.7%) living with HIV. Adolescent girls and young women living with HIV (AGYWLHIV) aged 15-24 reported screening less often (917 (13.7%)) than their peers with unknown (1677 (38.8%)) or positive HIV status (27278 (43.9%)) (P<0.001), or older women. The ATE of screening was 0 for women with unknown or positive HIV status, for whom the RDD was valid. Conclusion: We found no evidence the 2013 WHO guidelines increased or reduced womens cervical pre-cancer screening. However, AGYWLHIV reported screening less often. Policy makers should lower the age to start screening WLHIV from 25 to 15 to screen more AGYWLHIV. Studies are required to examine the impact of the guidelines on cervical pre-cancer screening in more countries.

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Section: Discussionmentioning

confidence: 77%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Impact of the 2013 WHO guidelines for screening and treatment of cervical precancerous lesions on women’s screening rates, by HIV-status, in East and Southern Africa: A regression discontinuity design analysis

Chipanta,

Osborne,

Bohlius

et al. 2024

Preprint

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Global, regional, and national burdens of HIV/AIDS acquired through sexual transmission 1990–2019: an observational study

Wu,

Zhou,

Chen

et al. 2024

Sex. Health

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Background Sexual transmission accounts for a substantial proportion of HIV infections. Although some countries are experiencing an upward trend in HIV infections, there has been a lack of studies assessing the global burden of HIV/AIDS acquired through sexual transmission. We assessed the global, regional, and national burdens of HIV/AIDS acquired through sexual transmission from 1990 to 2019. Methods Data on deaths, years of life lost (YLLs), years lived with disability (YLDs), and disability-adjusted life years (DALY) of HIV/AIDS acquired through sexual transmission in 204 countries and territories from 1990 to 2019 were retrieved from the Global Burden of Disease Study (GBD) 2019. The burdens and trends were evaluated using the age-standardised rates (ASR) and estimated annual percentage change (EAPC). Results Globally, HIV/AIDS acquired through sexual transmission accounted for ~695.8 thousand (95% uncertainty interval 628.0–811.3) deaths, 33.0 million (28.7–39.9) YLLs, 3.4 million (2.4–4.6) YLDs, and 36.4 million (32.2–43.1) DALYs in 2019. In 2019, Southern sub-Saharan Africa (11350.94), Eastern sub-Saharan Africa (3530.91), and Western sub-Saharan Africa (2037.74) had the highest ASR of DALYs of HIV/AIDS acquired through sexual transmission per 100,000. In most regions of the world, the burden of HIV/AIDS acquired through sexual transmission has been increasing from 1990 to 2019, mainly in Oceania (EAPC 17.20, 95% confidence interval 12.82–21.75), South Asia (9.00, 3.94–14.30), and Eastern Europe (7.09, 6.35–7.84). Conclusions HIV/AIDS acquired through sexual transmission results in a major burden globally, regionally, and nationally.

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Associations of inter-annual rainfall decreases with subsequent HIV outcomes for persons with HIV on antiretroviral therapy in Southern Africa: a collaborative analysis of cohort studies

Trickey,

Johnson,

Fung

et al. 2023

BMC Infect Dis

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Background Periods of droughts can lead to decreased food security, and altered behaviours, potentially affecting outcomes on antiretroviral therapy (ART) among persons with HIV (PWH). We investigated whether decreased rainfall is associated with adverse outcomes among PWH on ART in Southern Africa. Methods Data were combined from 11 clinical cohorts of PWH in Lesotho, Malawi, Mozambique, South Africa, Zambia, and Zimbabwe, participating in the International epidemiology Databases to Evaluate AIDS Southern Africa (IeDEA-SA) collaboration. Adult PWH who had started ART prior to 01/06/2016 and were in follow-up in the year prior to 01/06/2016 were included. Two-year rainfall from June 2014 to May 2016 at the location of each HIV centre was summed and ranked against historical 2-year rainfall amounts (1981–2016) to give an empirical relative percentile rainfall estimate. The IeDEA-SA and rainfall data were combined using each HIV centre’s latitude/longitude. In individual-level analyses, multivariable Cox or generalized estimating equation regression models (GEEs) assessed associations between decreased rainfall versus historical levels and four separate outcomes (mortality, CD4 counts < 200 cells/mm3, viral loads > 400 copies/mL, and > 12-month gaps in follow-up) in the two years following the rainfall period. GEEs were used to investigate the association between relative rainfall and monthly numbers of unique visitors per HIV centre. Results Among 270,708 PWH across 386 HIV centres (67% female, median age 39 [IQR: 32–46]), lower rainfall than usual was associated with higher mortality (adjusted Hazard Ratio: 1.18 [95%CI: 1.07–1.32] per 10 percentile rainfall rank decrease) and unsuppressed viral loads (adjusted Odds Ratio: 1.05 [1.01–1.09]). Levels of rainfall were not strongly associated with CD4 counts < 200 cell/mm3 or > 12-month gaps in care. HIV centres in areas with less rainfall than usual had lower numbers of PWH visiting them (adjusted Rate Ratio: 0.80 [0.66–0.98] per 10 percentile rainfall rank decrease). Conclusions Decreased rainfall could negatively impact on HIV treatment behaviours and outcomes. Further research is needed to explore the reasons for these effects. Interventions to mitigate the health impact of severe weather events are required.

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Regression discontinuity analysis demonstrated varied effect of Treat-All on CD4 testing among Southern African countries

Abstract: Regression discontinuity analysis demonstrated varied effect of Treat-All on CD4 testing among Southern African countries,

Cited by 3 publications

References 30 publications

Impact of the 2013 WHO guidelines for screening and treatment of cervical precancerous lesions on women’s screening rates, by HIV-status, in East and Southern Africa: A regression discontinuity design analysis

Impact of the 2013 WHO guidelines for screening and treatment of cervical precancerous lesions on women’s screening rates, by HIV-status, in East and Southern Africa: A regression discontinuity design analysis

Global, regional, and national burdens of HIV/AIDS acquired through sexual transmission 1990–2019: an observational study

Associations of inter-annual rainfall decreases with subsequent HIV outcomes for persons with HIV on antiretroviral therapy in Southern Africa: a collaborative analysis of cohort studies

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