학술논문
Decreasing time to antiretroviral therapy initiation after HIV diagnosis in a clinic?based observational cohort study in four African countries
Document Type
Report
Author
Esber, Allahna L.; Coakley, Peter; Ake, Julie A.; Bahemana, Emmanuel; Adamu, Yakubu; Kiweewa, Francis; Maswai, Jonah; Owuoth, John; Robb, Merlin L.; Polyak, Christina S.; Crowell, Trevor A.; Parikh, A; Hern, J; Falodun, O; Song, K; Milazzo, M; Dear, N; Francisco, L; Mankiewicz, S; Schech, S; Golway, A; Mebrahtu, T; Lee, E; Bohince, K; Hamm, T; Lombardi, K; Imbach, M; Eller, L; Peel, S; Malia, J; Kroidl, A; Kroidl, I; Geldmacher, C; Kafeero, C; Nambuya, A; Tegamanyi, J; Birungi, H; Mugagga, O; Nassali, G; Wangiri, P; Nantabo, M; Nambulondo, P; Atwijuka, B; Asiimwe, A; Nabanoba, Ct; Semwogerere, M; Mwesigwa, R; Jjuuko, S; Namagembe, R; Bagyendagye, E; Tindikahwa, A; Rwomushana, I; Ssentongo, F; Kibuuka, H; Millard, M; Kapkiai, J; Wangare, S; Mangesoi, R; Chepkwony, P; Bor, L; Maera, E; Kasembeli, A; Rotich, J; Kipkoech, C; Chepkemoi, W; Rono, A; Kesi, Zeddy; Ngeno, Janet; Langat, Edwin; Labosso, Keneddy; Langat, Ken; Kirui, Robert; Rotich, L; Mabwai, M; Chelangat, E; Agutu, J; Tonui, C; Changwony, E; Bii, M; Chumba, E; Korir, J; Sugut, J; Gitonga, D; Ngetich, R; Kiprotich, S; Rehema, W; Ogari, C; Ouma, I; Adimo, O; Ogai, S; Okwaro, C; Maranga, E; Ochola, J; Obambo, K; Sing'Oei, V; Otieno, L; Nyapiedho, O; Sande, N; Odemba, E; Wanjiru, F; Khamadi, S; Chiweka, E; Lwilla, A; Mkondoo, D; Somi, N; Kiliba, P; Nwando, M; Mwaisanga, G; Muhumuza, J; Mkingule, N; Mwasulama, O; Sanagare, A; Kishimbo, P; David, G; Mbwayu, F; Mwamwaja, J; Likiliwike, J; Muhumuza, J; Mcharo, R; Mkingule, N; Mwasulama, O; Mtafya, B; Lueer, C; Kisinda, A; Mbena, T; Mfumbulwa, H; Mwandumbya, L; Edwin, P; Olomi, W; Adamu, Y; Akintunde, A; Tiamiyu, Ab; Afoke, K; Mohammed, S; Harrison, Ne; Agbaim, Uc; Adegbite, Oa; Parker, Z; Adelakun, Ga; Oni, Fo; Ndbuisi, Ro; Elemere, J; Azuakola, N; Williams, Tt; Ayogu, M; Enas, O; Enameguono, O; Odo, Af; Ukaegbu, Ic; Ugwuezumba, O; Odeyemi, So; Okeke, Nc; Umeji, L; Rose, A; Daniel, H; Nwando, H; Nicholas, Ei; Iyanda, T; Okolo, C; Mene, Vy; Dogonyaro, B; Olabulo, O; Akinseli, O; Onukun, F; Knopp, G
Source
Journal of the International AIDS Society. February 2020, Vol. 23 Issue 2
Subject
Language
English
ISSN
1758-2652
Abstract
Abstract: Introduction: World Health Organization (WHO) guidelines have shifted over time to recommend earlier initiation of antiretroviral therapy (ART) and now encourage ART initiation on the day of HIV diagnosis, if possible. However, barriers to ART access may delay initiation in resource?limited settings. We characterized temporal trends and other factors influencing the interval between HIV diagnosis and ART initiation among participants enrolled in a clinic?based cohort across four African countries. Methods: The African Cohort Study enrols adults engaged in care at 12 sites in Uganda, Kenya, Tanzania and Nigeria. Participants provide a medical history, complete a physical examination and undergo laboratory assessments every six months. Participants with recorded dates of HIV diagnosis were categorized by WHO guideline era ( Results and discussion: From January 2013 to September 2019, a total of 2888 adults living with HIV enrolled with known diagnosis dates. Median time to ART initiation decreased from 22.0 months (interquartile range (IQR) 4.0 to 77.3) among participants diagnosed prior to 2006 to 0.5 months (IQR 0.2 to 1.8) among those diagnosed in 2016 and later. Comparing those same periods, CD4 nadir increased from a median of 166 cells/mm[sup.3] (IQR: 81 to 286) to 298 cells/mm[sup.3] (IQR: 151 to 501). In the final adjusted model, participants diagnosed in each subsequent WHO guideline era had increased rates of ART initiation compared to those diagnosed before 2006. CD4 nadir ?500 cells/mm[sup.3] was independently associated with a lower rate of ART initiation as compared to CD4 nadir 50 years at diagnosis was independently associated with shorter time to ART initiation as compared to 18 to 29 years (HR: 1.38; 95% CI: 1.19 to 1.61). Conclusions: Consistent with changing guidelines, the interval between diagnosis and ART initiation has decreased over time. Still, many adults living with HIV initiated treatment with low CD4, highlighting the need to diagnose HIV earlier while improving access to immediate ART after diagnosis.
Introduction The introduction of antiretroviral therapy (ART) proved a turning point in the fight against HIV, leading to dramatic decreases in HIV?related morbidity and mortality. However, the first ART regimens [...]
Introduction The introduction of antiretroviral therapy (ART) proved a turning point in the fight against HIV, leading to dramatic decreases in HIV?related morbidity and mortality. However, the first ART regimens [...]