Timeliness of antiretroviral therapy initiation in the era before universal treatment

Bogdanić, Nikolina; Bendig, L; Lukas, Davorka; Zekan, Šime; Begovać, Josip

doi:10.1038/s41598-021-90043-7

Cited by 9 publications

(13 citation statements)

References 31 publications

(26 reference statements)

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“…This result is in line with study results from Kampala, Uganda that reported the median time to ART initiation was 6 days, 8 and review of evidence regarding rapid ART initiation, which revealed that newly diagnosed HIV-positive individuals on average started ART within 7 days of a confirmed positive HIV diagnosis. 37 However, this is shorter than in study results conducted in Myanmar, 32 Croatia, 38 and Melbourne, Australia 39 which reported the median time to ART initiation as of 29, 30, and 77 days respectively. The variation may be due to the different criteria used to initiate ART for newly diagnosed HIV-positive individuals.…”

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confidence: 71%

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Time to Antiretroviral Therapy Initiation and Its Predictors Among Newly Diagnosed HIV-Positive People in Nekemte Town, Western Ethiopia: Claim of Universal Test and Treat

Bayisa¹,

Abera²,

Mulisa³

et al. 2021

HIV

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Background: HIV continuum of care demands early ART initiation for all HIV-infected individuals. Early ART initiation reduces onward HIV transmission facilitating rapid viral suppression. Despite this, delayed ART use is a challenge among newly diagnosed HIVpositive individuals, and there is limited evidence on time to ART initiation among this group in Ethiopia. Thus, this study aimed to assess time to ART initiation and its predictors among newly diagnosed HIV-positive individuals in Nekemte town, Western Ethiopia. Methods: An institution-based retrospective follow-up study was conducted on 518 newly diagnosed HIV-positive people from September 5, 2016 to December 20, 2020 at Nekemte town, Western Ethiopia. Data were collected from ART intake forms, registration log books and patient charts. The collected data were entered into Epi Data version 3.1 and STATA version 14.0 was used for analysis. Survival probability was checked graphically by Kaplan-Meier curve and statistically by Log rank test. Both bivariable and multivariable Cox Proportional hazards regression models were conducted to identify the predictors of ART initiation. Hazard ratio with 95% CI and p-value of <0.05 was used to declare a statistical significance. Results: By the end of the follow-up, 371 (71.6%) individuals had initiated ART with an overall incidence rate of 51.9 per 1000 [95% CI: 54.07-66.32] person days; median time to ART initiation was 4 [IQR: 1-9] days. Being female (AHR = 1.33, 95% CI: 1.06-1.67), urban dwellers (AHR = 2.02, 95% CI: 1.37-2.97), having baseline OIs (AHR = 1.62, 95% CI: 1.60-4.30); being tested via VCT (AHR = 1.33, 95% CI: 1.02-1.74); linked from OPD (AHR = 0.64, 95% CI: 0.47-0.85); disclosing HIV sero-status (AHR = 2.07, 95% CI: 1.17-3.68); and college and above education level (AHR = 1.43, 95% CI: 1.00-2.0) were identified as significant predictors of early initiation of ART. Conclusion:The proportion and incidence of ART initiation was high; a short median time to ART initiation was revealed in this study. Strictly screening OIs, encouraging HIV serostatus disclosure and voluntary HIV testing are recommended to increase early ART initiation.

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confidence: 71%

“…The median age of newly diagnosed HIV positive people was 35 [IQR: [27][28][29][30][31][32][33][34][35][36][37][38][39][40][41] years. The majority of the study participants (164; 31.66%) were found in age category of ≥40 years old.…”

Section: Socio-demographic Characteristics Of Study Participantsmentioning

confidence: 99%

Time to Antiretroviral Therapy Initiation and Its Predictors Among Newly Diagnosed HIV-Positive People in Nekemte Town, Western Ethiopia: Claim of Universal Test and Treat

Bayisa¹,

Abera²,

Mulisa³

et al. 2021

HIV

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“…The median (IQR) survival time-to-ART-initiation in the present study was 6 (IQR: 0-5414) days. This finding is similar to 5 (IQR 1-13) days median time from West African countries – Burkina Faso, Cote d’ Ivoire, Mali, and Togo, [94], and similar to 4 (IQR 1-9) days from Ethiopia study [95] but was much lower than 29 (IQR: 0-514) days from UK study [73], lower than 21 (IQR: 17-39) days from Portugal [96] and from Republic of South Africa (RSA) [97] and, than 31 (QI-Q3: 8-537.5) days in Croatia [98]. Furthermore, in another RSA study, median time to ART-initiation was 12 (IQR: 1-59) days [99].…”

Section: Discussionmentioning

confidence: 95%

“…As a marker of response to ART, viral loads were mostly used to monitor therapy effectiveness following initiation [7]. The present UTT strategy of initiating ART early with definitive lag-time references [98], is the update of initial recommendations of commencing ARVs during “early” HIV infection; where “early” was defined as period up to 6 months after HIV diagnosis [130–133]. In line with current global recommendations, Malawi adopted the UTT strategy in 2016 and embedded it in her successive “Integrated clinical guidelines for HIV management” [134, 135].…”

Section: Discussionmentioning

confidence: 99%

Predictors of Time-to-ART-Initiation Survival Times in a Random Sample of Adults Living with HIV from Malawi – A Historical, Nationally Representative Cohort Sample of 2004-2015 HIV Data

Salema

2024

Preprint

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BackgroundDespite globally adapted universal test-and-treat (UTT) strategy of HIV management, survival time-to-antiretroviral-therapy initiation (TTAT) remains heterogenous and affected by diverse factors which remain unexplained in Malawi. This study explored correlates to TTAT-initiation in Malawi among adults living with HIV.MethodsA multicentre retrospective cohort study was undertaken from eight centres. Medical records of (n=9,953) adult patients aged 15+ years old, were reviewed. A life table, the Kaplan-Meier log-rank, and Cox Proportion Hazard regression were used to calculate survival TTAT-initiation and its correlates, respectively. Adjusted Hazard ratio less than 1 (aHR <1) signified factors negatively associated, while aHR >1 meant factors positively associated with TTAT-initiation. Hazard ratio with 95% Confidence interval (95%CI) andp<0.05 were used to declare statistical significance.ResultsData from (n=9,953) adult HIV patients were abstracted from hospital medical records. Patients median age was 40 (IQR: 33-48 years). 60.8% were females, 45.2% were younger adults of 20-39 years, and 78.8% were either married or cohabiting. 48.1% had advanced HIV disease; WHO clinical stage III, 24.5% had WHO stage IV, whereas 27.5% were asymptomatic; thus; 24.9% initiated ART due to low CD4+ count and 2.6% under PMTCT’s Option-B+. Findings from TTAT-initiation survival function analysis show that each patient had a single entry into the study and provided a total of 5,414 event-time-intervals, giving a 100% total event-failure without censored observations. Mean and median survival times were 527.2 days and 6 (IQR 0-5,414) days, respectively. Treatment-initiation (time at risk) was observed at the rate of 0.002 per 5,247,268 person-years. From multivariable Cox PH regression analysis, independent factors identified to be negatively associated with early (timely) antiretroviral treatment-initiation included; older age of 55+ years by 16% [aHR 0.84, 95%CI: (0.71–0.97)], male gender by 4% [aHR=0.96, 95%CI: (0.92–0.98)], bacterial causes by 5% [aHR=0.95, 95%CI: (0.89–0.99)], mycobacterial causes by 14% [aHR=0.86, 95%CI: (0.81–0.92)], high viraemia VL>1,000 copies/mL by 17% [aHR=0.83, 95%CI: (0.81–0.95)], registered in secondary tier and tertiary tier health facilities by 21% [aHR 0.79, 95%CI: (0.73-0.86) and 14% [aHR 0.86, 95%CI: (0.79-0.93) respectively, longer HIV survivorship (duration) by 58% to 85%, and having respiratory symptoms like coughing or breathlessness by 7% [0.93 95%CI: (0.88–0.97)]. These factors acted as barriers to early time-to-ART-initiation. In contrast younger adults of 20-39 years; [aHR=1.04, 95%CI: (1.02–1.19)], early mid-aged patients of 40-54 years; [aHR=1.03, 95%CI: (1.01– 1.21)], incomplete basic education level; [aHR 1.09, 95%CI: (1.02-1.20)], secondary education level; [aHR=1.06, 95%CI: (1.01-1.12)], Northern and Southern regions ethnicity; [aHR=1.07, 95%CI: (1.02–1.16)] and [aHR=1.06, 95%CI: (1.01–1.12) respectively, manifesting chronic headache or fevers; [aHR=1.12, 95%CI: (1.04–1.21)], being asymptomatic; [aHR=1.02, 95%CI: (1.02–1.13), (p<0.041)], being immunosuppressed with WHO clinical stage III; [aHR=1.86, 95%CI: (1.21-3.45)], WHO clinical stage IV; [aHR=2.80, 95%CI: (1.20-3.22)], protozoal pathological infection; [aHR=1.06, 95%CI: (1.02-1.15)], low CD4+ cell count <250 cells/µL; [aHR=1.05, 95%CI: (1.01–1.09), self-employment [aHR=1.04, 95%CI: (1.00–1.09)], and year of HIV diagnosis variable, were all positively associated with treatment-initiation and acted as precursors to early (timely) ART-initiation.ConclusionThe study demonstrates that apart from meeting clinical eligible, different clinical and nonclinical factors contributed to time-to-treatment initiation among adults living with HIV. These factors; which are still prevalent in Malawi, have contributed to the spiralling and high mortality and morbidity from HIV/AIDS in Malawi and– hence, a knowledge of their existence, coupled with efforts to counteract and halt their occurrences, and strategies to strengthen and sustain the gained milestones in all tiers of health facility establishments across Malawi cannot be overemphasised.

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“…Croatia has a centralized system of HIV care, and all persons living with HIV (PLWH) are treated at the University Hospital for Infectious Diseases (UHID) in Zagreb [ 5 , 6 , 7 ]. The PrEP service was introduced in Croatia as a pilot project in September 2018, and this service is still available only at the HIV Outpatient Department at the UHID in Zagreb.…”

Section: Methodsmentioning

confidence: 99%

Hepatitis A Outbreak in Men Who Have Sex with Men Using Pre-Exposure Prophylaxis and People Living with HIV in Croatia, January to October 2022

Bogdanić

Begovać

Močibob

et al. 2022

Viruses

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The hepatitis A virus (HAV) is a highly hepatotropic virus transmitted mainly via the fecal–oral route. The purpose of this study is to describe a prolonged HAV outbreak in HIV-infected men who have sex with men (MSM) and pre-exposure prophylaxis (PrEP) users in Croatia in 2022. Croatia has a centralized system of HIV care and the PrEP service is only available at the University Hospital for Infectious Diseases (UHID), Zagreb. We reviewed all MSM living with HIV and MSM PrEP users at UHID and identified those diagnosed with HAV between January and October 2022. During this period, a total of 1036 MSM living with HIV and 361 PrEP users were followed, and 45 (4.4%) and 32 (8.9%) were diagnosed with HAV, respectively. Most cases were diagnosed in mid-February. A total of 70.1% (726/1036) MSM living with HIV and 82.3% (297/361) PrEP users were susceptible to HAV. Sequencing information was available for 34 persons; in all cases the HAV subtype IA was found. Our findings indicate that both MSM living with HIV and HIV-uninfected PrEP users are vulnerable to HAV infection and might be a potential source for a more widespread HAV epidemic.

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Timeliness of antiretroviral therapy initiation in the era before universal treatment

Cited by 9 publications

References 31 publications

Time to Antiretroviral Therapy Initiation and Its Predictors Among Newly Diagnosed HIV-Positive People in Nekemte Town, Western Ethiopia: Claim of Universal Test and Treat

Time to Antiretroviral Therapy Initiation and Its Predictors Among Newly Diagnosed HIV-Positive People in Nekemte Town, Western Ethiopia: Claim of Universal Test and Treat

Predictors of Time-to-ART-Initiation Survival Times in a Random Sample of Adults Living with HIV from Malawi – A Historical, Nationally Representative Cohort Sample of 2004-2015 HIV Data

Hepatitis A Outbreak in Men Who Have Sex with Men Using Pre-Exposure Prophylaxis and People Living with HIV in Croatia, January to October 2022

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