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. 2020 Aug 4;222(5):755-764.
doi: 10.1093/infdis/jiz547.

Impact of Universal Antiretroviral Treatment Eligibility on Rapid Treatment Initiation Among Young Adolescents with Human Immunodeficiency Virus in Sub-Saharan Africa

Olga Tymejczyk  1 , Ellen Brazier  1 , Kara Wools-Kaloustian  2 , Mary-Ann Davies  3 , Madeline Dilorenzo  1   4 , Andrew Edmonds  5 , Rachel Vreeman  6 , Carolyn Bolton  7 , Christella Twizere  8 , Nicollate Okoko  9 , Sam Phiri  10 , Gertrude Nakigozi  11 , Patricia Lelo  12 , Per von Groote  13 , Annette H Sohn  14 , Denis Nash  1   15
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Impact of Universal Antiretroviral Treatment Eligibility on Rapid Treatment Initiation Among Young Adolescents with Human Immunodeficiency Virus in Sub-Saharan Africa

Olga Tymejczyk et al. J Infect Dis. .

Abstract

Background: Young adolescents with perinatally acquired human immunodeficiency virus (HIV) are at risk for poor care outcomes. We examined whether universal antiretroviral treatment (ART) eligibility policies (Treat All) improved rapid ART initiation after care enrollment among 10-14-year-olds in 7 sub-Saharan African countries.

Methods: Regression discontinuity analysis and data for 6912 patients aged 10-14-years were used to estimate changes in rapid ART initiation (within 30 days of care enrollment) after adoption of Treat All policies in 2 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 than in those adopting it in 2013: 23.4 percentage points (pp) (95% confidence interval, 13.9-32.8) versus 11.2pp (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 per year afterward.

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.

Keywords: ART eligibility; ART initiation; Treat All; adolescents; regression discontinuity; sub-Saharan Africa.

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Figures

Figure 1.
Figure 1.
Proportions of adolescents 10–14 years old initiating antiretroviral treatment (ART) rapidly (within 30 days of enrollment in human immunodeficiency virus care) in the years before and after Treat All adoption, by country or region.
Figure 2.
Figure 2.
Trends in rapid antiretroviral treatment (ART) initiation before and after Treat All adoption among adolescents 10–14 years old, by year of adoption.
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