Changes in rapid HIV treatment initiation after national “treat all” policy adoption in 6 sub-Saharan African countries: Regression discontinuity analysis
PLoS Medicine Jul 11, 2019
Tymejczyk O, et al. - In view of the World Health Organization recommendation of initiating antiretroviral treatment (ART) in all people living with HIV (“treat all”), regardless of disease stage and CD4 cell count, researchers sought to assess the impact of treat all policies on uptake of ART in real-world implementation settings. In 6 countries in sub-Saharan Africa (Burundi, Kenya, Malawi, Rwanda, Uganda, and Zambia), rapid ART initiation (ie, ART initiation within 30 days of enrolling into HIV care) was assessed among 814,603 patients before and after national adoption of treat all policies. Following national adoption of treat all, large increases in rapid ART initiation were observed, with 81.6% of patients initiating ART within 30 days of enrollment after the policy adoption. Patients with different immunodeficiency status, as measured by CD4 counts showed little difference in rapid ART initiation. Men and young adults (aged 16–24 years) vs women and older adults, respectively, less frequently rapidly initiated ART in the period following treat all adoption. However, there was a significant reduction in the risk of failing to rapidly initiate ART with elapsed time after treat all policy adoption for all groups.
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