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Toward Universal HIV Treatment in Haiti: Time Trends in ART Retention Following Expanded ART Eligibility in a National Cohort from 2011-17
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6 01 2020
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Source: J Acquir Immune Defic Syndr. 84(2):153-161
Details:
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Alternative Title:J Acquir Immune Defic Syndr
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Personal Author:
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Description:Background
The World Health Organization (WHO) recommends universal antiretroviral therapy (ART) for people living with HIV (PLWH), but evidence about effects of expanded ART access on ART retention in low-resource settings is limited.
Setting
Haiti’s Ministry of Health endorsed universal ART for pregnant women in March 2013 (Option B+) and for all PLWH in July 2016. This study included 51,579 ART patients from 2011–17 at 94 hospitals and clinics in Haiti.
Methods
This observational, retrospective cohort study described time trends in 6-month ART retention using secondary data, and compared results during three time periods using an interrupted time series (ITS) model: pre-Option B+ (period 1: 1/11–2/13), Option B+ (period 2: 3/13–6/16), and Test and Start (T&S, period 3: 7/16–9/17).
Results
From the pre-Option B+ to the T&S period, the monthly count of new ART patients increased from 366/month to 877/month, and the proportion with same-day ART increased from 6.3% to 42.1% (p<0.001). The proportion retained on ART after 6 months declined from 78.4% to 75.0% (p<0.001). In the ITS model, ART retention improved by a rate of 1.4% per quarter during the T&S period after adjusting for patient characteristics (Adjusted Incidence Rate Ratio [aIRR]=1.014; 95% confidence interval [CI]: 1.002–1.026, p<0.001). However, patients with same-day ART were 14% less likely to be retained compared to those starting ART >30 days after HIV diagnosis (aIRR=0.86; 95% CI: 0.84–0.89, p<0.001).
Conclusion
Achieving targets for HIV epidemic control will require increasing ART retention and reducing the disparity in retention for those with same-day ART.
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Pubmed ID:32084052
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Pubmed Central ID:PMC7228851
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Volume:84
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Issue:2
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