Regression discontinuity analysis demonstrated varied effect of Treat-All on CD4 testing among Southern African countries.

Zaniewski, Elizabeth; Brazier, Ellen; Dao Ostinelli, Cam Ha; Wood, Robin; Osler, Meg; Technau, Karl-Günter; van Oosterhout, Joep J; Maxwell, Nicola; van Dijk, Janneke; Prozesky, Hans; Fox, Matthew P; Bor, Jacob; Nash, Denis; Egger, Matthias (2021). Regression discontinuity analysis demonstrated varied effect of Treat-All on CD4 testing among Southern African countries. (In Press). Journal of clinical epidemiology, 140, pp. 101-110. Elsevier 10.1016/j.jclinepi.2021.09.001

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OBJECTIVE

To determine whether Treat-All policy impacted laboratory testing practices of antiretroviral therapy (ART) programs in Southern Africa.

STUDY DESIGN AND SETTING

We used HIV cohort data from Lesotho, Malawi, Mozambique, South Africa, Zambia and Zimbabwe in a regression discontinuity design to estimate changes in pre-ART CD4 testing and viral load monitoring following national Treat-all adoption that occurred during 2016-2017. This study included more than 230,000 ART-naïve people living with HIV (PLHIV) aged five years or older who started ART within two years of national Treat-All adoption.

RESULTS

We found pre-ART CD4 testing decreased following adoption of Treat-All recommendations in Malawi (-21.4 percentage points (pp), 95% CI: -26.8, -16.0) and in Mozambique (-8.8pp, 95% CI: -14.9, -2.8), but increased in Zambia (+2.7pp, 95% CI: +0.4, +5.1). Treat-All policy had no effect on viral load monitoring, except among females in South Africa (+7.1pp, 95% CI: +1.1, +13.0).

CONCLUSION

Treat-All policy expanded ART eligibility, but led to reductions in pre-ART CD4 testing in some countries that may weaken advanced HIV disease management. Continued and expanded support of CD4 and viral load laboratory capacity is needed to further improve treatment successes and allow for uniform evaluation of ART implementation across Southern Africa.

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:

Zaniewski, Anne Elizabeth; Dao Ostinelli, Cam Ha and Egger, Matthias

Subjects:

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

ISSN:

0895-4356

Publisher:

Elsevier

Funders:

[4] Swiss National Science Foundation

Language:

English

Submitter:

Andrea Flükiger-Flückiger

Date Deposited:

17 Sep 2021 08:58

Last Modified:

11 Oct 2021 01:33

Publisher DOI:

10.1016/j.jclinepi.2021.09.001

PubMed ID:

34487837

Uncontrolled Keywords:

CD4 lymphocyte count HIV infection, regression discontinuity design Southern Africa antiretroviral therapy viral load

BORIS DOI:

10.48350/159354

URI:

https://boris.unibe.ch/id/eprint/159354

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