Same-day HIV testing with initiation of antiretroviral therapy versus standard care for persons living with HIV: A randomized unblinded trial

Koenig, Serena P.; Dorvil, Nancy; Dévieux, Jessy G.; Hedt‐Gauthier, Bethany; Riviere, Cynthia; Faustin, Mikerlyne; Lavoile, Kerlyne; Perodin, Christian; Apollon, Alexandra; Duverger, Limathe; McNairy, Margaret L.; Hennessey, Kelly A.; Souroutzidis, Ariadne; Crémieux, Pierre‐Yves; Sévère, Patrice; Pape, Jean William

doi:10.1371/journal.pmed.1002357

Cited by 216 publications

(244 citation statements)

References 25 publications

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“…Rosen 2016 assessed readiness to start ART during counselling sessions. McNairy 2017 used a checklist, and Koenig 2017 assessed readiness through a survey administered by a social worker.…”

Section: Resultsmentioning

confidence: 99%

“…At the individual level, two studies included short message service (SMS) visit reminders or noncash financial incentives, or both (Elul 2017; Koenig 2017; McNairy 2017). Other studies expedited drug dispensing at the pharmacy for those randomized to the rapid ART arm (Rosen 2016), or included additional information highlighting the importance of adherence to treatment (Labhardt 2018).…”

Section: Resultsmentioning

confidence: 99%

“…Elul 2017 and McNairy 2017 classified participants as retained in care if they attended a clinic visit within the 90 days prior to the end of the study (12 months after randomization). Koenig 2017 defined retention in care as attending the 12‐month visit (1 clinic visit between 12 and 15 months after HIV testing). Rosen 2016 classified participants as retained in care if they attended a clinic visit within 5 to 10 months after study enrolment.…”

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%

“…There is high heterogeneity between studies. Although this is partly explained by the different designs (for example, Koenig 2017 and Rosen 2016 offered ART on same day of diagnosis/enrolment, whilst Amanyire 2016 aimed to offer it within 14 days of diagnoses), heterogeneity remains high when similar studies are grouped together. m Downgraded by two for imprecision.…”

Section: Summary Of Findingsmentioning

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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“…Rosen 2016 assessed readiness to start ART during counselling sessions. McNairy 2017 used a checklist, and Koenig 2017 assessed readiness through a survey administered by a social worker.…”

Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Section: Summary Of Findingsmentioning

confidence: 99%

See 3 more Smart Citations

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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Progress Toward Achieving UNAIDS 90-90-90 in Rural Communities in East Africa

Rı́o

Armstrong

2017

JAMA

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In recent years, the results of several studies, including Human Immunodeficiency Virus (HIV) Prevention Trials Network (HPTN) 052, 1 Strategic Timing of Antiretroviral Treatment (START), 2 and Trial of Early Antiretrovirals and Isoniazid Preventive Therapy in Africa (TEMPRANO), 3 have rapidly changed the global approach to HIV treatment and have raised the possibility of ending AIDS by 2030. These 3 studies demonstrated that HIVinfected persons with viral suppression receiving antiretroviral therapy (ART) do not transmit HIV to their uninfected sex partners, 1 and that initiating ART resulted in net health benefits to HIV-infected persons in high-income and lowincome countries regardless of CD4 lymphocyte count. 2,3 In sum, ART has been shown to be beneficial for individual and public health and that "treatment is prevention."In response to the scientific evidence that treatment is prevention, in 2014 the Joint United Nations Programme on HIV/AIDS (UNAIDS) issued a call to action known as 90-90-90. This initiative set ambitious targets to be reached by 2020: 90% of all persons living with HIV will know their status; of these, 90% will receive antiretroviral therapy (ART); and 90% of those receiving therapy will have HIV viral suppression. As a result, 73% of all people living with HIV will achieve viral suppression, a 2-fold to 3-fold increase from estimates of suppression in 2014. 4 Soon after, in 2015, WHO recommended treatment for all HIV-infected persons regardless of CD4 cell count. 5 When 90-90-90 was launched, despite the rapid scale-up of ART globally, many were skeptical that these goals could be reached, due in part to the level funding environment that threatened to slow the pace of the response. In 2015, with only 5 years to reach 90-90-90, UNAIDS estimated that although 17 million people were receiving ART globally, only 57% of people living with HIV knew their HIV status, 46% were receiving ART, and 38% had achieved HIV viral suppression. 6 Innovative, cost-effective, proven, and scalable strategies are needed if the 90-90-90 goal is to be met.The percentage of people aware of their HIV status varies widely between countries. Among countries with more robust HIV testing programs, close to 90% of people with HIV infection are aware of their HIV status, whereas in other regions (ie, West and Central Africa, North Africa, and the Middle East), less than 40% are aware of their HIV status. All subsequent steps in the 90-90-90 campaign depend on maximizing testing, which is critically important. For this reason, in fiscal year 2015, the President's Emergency Plan

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