Toward Universal HIV Treatment in Haiti: Time Trends in ART Retention Following Expanded ART Eligibility in a National Cohort from 2011-17

Details

• Journal Article:
  J Acquir Immune Defic Syndr
• Personal Author:
  Puttkammer, Nancy ; Parrish, Canada ; Desir, Yrvel ; Hyppolite, Nathaelf ; Wagenaar, Bradley ; Joseph, Nadjy ; Hall, Lara ; Honoré, Jean Guy ; Robin, Ermane ; Perrin, Georges ; François, Kesner
  More +
• 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.
• Subjects:
  • Adult
  • Anti-HIV Agents
  • Cohort Studies
  • Female
  • HIV Infections
  • HIV-1
  • Haiti
  • Humans
  • Male
  • Retrospective Studies
• Keywords:
  • antiretroviral therapy (ART)
  • Haiti
  • universal treatment
  • same-day treatment
  • ART retention
  • implementation science
• Source:
  J Acquir Immune Defic Syndr. 84(2):153-161
• DOI:
  http://dx.doi.org/10.1097/QAI.0000000000002329
• Pubmed ID:
  32084052
• Pubmed Central ID:
  PMC7228851
• Document Type:
  Text ; Journal Article
• Funding:
  P30 AI027757/AI/NIAID NIH HHSUnited States/ ; U2G GH001130/GH/CGH CDC HHSUnited States/ ; PEPFAR/PEPFARUnited States/
• Genre:
  Journal Article
• Volume:
  84
• Issue:
  2
• Download URL:
  https://stacks.cdc.gov/view/cdc/88022/cdc_88022_DS1.pdf
• File Type:
  [PDF - 558.46 KB]
• Collection(s):
  CDC Public Access
• Main Document Checksum:
  urn:sha-512:8789e97ee80be9a4b82a8a61f09281726d136ea6b3522d8a99ca5aa1312554d27e80df41bb9e4174ac31c68b39cc8d17e23886aa957b20b978e64bb249ae6ca4