Impact of universal antiretroviral treatment eligibility on rapid treatment initiation among young adolescents with HIV in sub-Saharan Africa.

Tymejczyk, Olga; Brazier, Ellen; Wools-Kaloustian, Kara; Davies, Mary-Ann; DiLorenzo, Madeline; Edmonds, Andrew; Vreeman, Rachel; Bolton, Carolyn; Twizere, Christella; Okoko, Nicollate; Phiri, Sam; Nakigozi, Gertrude; Lelo, Patricia; von Groote, Per; Sohn, Annette H; Nash, Denis (2020). Impact of universal antiretroviral treatment eligibility on rapid treatment initiation among young adolescents with HIV in sub-Saharan Africa. Journal of infectious diseases, 222(5), pp. 755-764. Oxford University Press 10.1093/infdis/jiz547

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BACKGROUND

Young adolescents with perinatally-acquired HIV are at risk for poor care outcomes. We examined whether universal antiretroviral treatment (ART) eligibility policies (Treat All) improved rapid ART initiation following care enrollment among 10-14-year-olds in seven sub-Saharan African countries.

METHODS

Regression discontinuity analysis and data for 6,912 10-14-year-old patients were used to estimate changes in rapid ART initiation (within 30 days of care enrollment) following adoption of Treat All policies in two groups of countries: Uganda and Zambia (policy adopted in 2013) and Burundi, Democratic Republic of the Congo, Kenya, Malawi, and Rwanda (policy adopted in 2016).

RESULTS

There were immediate increases in rapid ART initiation among young adolescents after national adoption of Treat All. Increases were greater in countries adopting the policy in 2016, compared with those adopting it in 2013: 23.4 percentage points (pp) (95%CI: 13.9-32.8) vs. 11.2pp (95%CI: 2.5-19.9). However, the rate of increase in rapid ART initiation among 10-14-year-olds rose appreciably in countries with earlier treatment expansions, from 1.5pp per year before Treat All to 7.7pp afterwards.

CONCLUSIONS

Universal ART eligibility has increased rapid treatment initiation among young adolescents enrolling in HIV care. Further research should assess their retention in care and viral suppression under Treat All.

Item Type:

Journal Article (Original Article)

Division/Institute:

04 Faculty of Medicine > Pre-clinic Human Medicine > Institute of Social and Preventive Medicine (ISPM)

UniBE Contributor:

von Groote, Per Maximilian

Subjects:

600 Technology > 610 Medicine & health
300 Social sciences, sociology & anthropology > 360 Social problems & social services

ISSN:

0022-1899

Publisher:

Oxford University Press

Language:

English

Submitter:

Andrea Flükiger-Flückiger

Date Deposited:

14 Nov 2019 15:56

Last Modified:

15 Aug 2020 06:13

Publisher DOI:

10.1093/infdis/jiz547

PubMed ID:

31682261

Uncontrolled Keywords:

ART eligibility ART initiation Treat All adolescents regression discontinuity sub-Saharan Africa

BORIS DOI:

10.7892/boris.134891

URI:

https://boris.unibe.ch/id/eprint/134891

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