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. 2019 Mar 1;80(3):e74-e83.
doi: 10.1097/QAI.0000000000001907.

Better Outcomes Among HIV-Infected Rwandan Children 18-60 Months of Age After the Implementation of "Treat All"

Stephen Arpadi  1 , Matthew Lamb  1 , Isaie N Nzeyimana  1 , Greet Vandebriel  1 , Gloria Anyalechi  2 , Marcia Wong  1 , Rebecca Smith  1 , Emilia D Rivadeneira  2 , Eugenie Kayirangwa  3 , Samuel S Malamba  3 , Canisious Musoni  3 , Emilia H Koumans  2 , Mollie Braaten  1 , Sabin Nsanzimana  4
Affiliations

Better Outcomes Among HIV-Infected Rwandan Children 18-60 Months of Age After the Implementation of "Treat All"

Stephen Arpadi et al. J Acquir Immune Defic Syndr. .

Abstract

Background: In 2012, Rwanda introduced a Treat All approach for HIV-infected children younger than 5 years. We compared antiretroviral therapy (ART) initiation, outcomes, and retention, before and after this change.

Methods: We conducted a retrospective study of children enrolled into care between June 2009 and December 2011 [Before Treat All (BTA) cohort] and between July 2012 and April 2015 [Treat All (TA) cohort].

Setting: Medical records of a nationally representative sample were abstracted for all eligible aged 18-60 months from 100 Rwandan public health facilities.

Results: We abstracted 374 medical records: 227 in the BTA and 147 in the TA cohorts. Mean (SD) age at enrollment was [3 years (1.1)]. Among BTA, 59% initiated ART within 1 year, vs. 89% in the TA cohort. Median time to ART initiation was 68 days (interquartile range 14-494) for BTA and 9 days (interquartile range 0-28) for TA (P < 0.0001), with 9 (5%) undergoing same-day initiation in BTA compared with 50 (37%) in TA (P < 0.0001). Before ART initiation, 59% in the BTA reported at least one health condition compared with 35% in the TA cohort (P < 0.0001). Although overall loss to follow-up was similar between cohorts (BTA: 13%, TA: 8%, P = 0.18), loss to follow-up before ART was significantly higher in the BTA (8%) compared with the TA cohort (2%) (P = 0.02).

Conclusions: Nearly 90% of Rwandan children started on ART within 1 year of enrollment, most within 1 month, with greater than 90% retention after implementation of TA. TA was also associated with fewer morbidities.

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Conflict of interest statement

The authors have no funding or conflicts of interest to disclose.

Figures

FIGURE 1.
FIGURE 1.
Sample selection of Before Treat All and Treat All cohorts.
FIGURE 2.
FIGURE 2.
A, Mean weight-for-age Z-score (based on WHO standards) after enrollment in HIV care/treatment. B, Mean weight-forage Z-score (based on WHO standards) after ART initiation.
FIGURE 3.
FIGURE 3.
A, Cumulative incidence of death or LTFU before ART initiation. P-value = 0.017. *Competing-risk cumulative incidence function treating ART initiation as a competing risk. B, Cumulative incidence of death or LTFU after ART initiation. P-value = 0.47.
See this image and copyright information in PMC

References

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