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Multicenter Study
. 2020 Nov 26;20(1):1802.
doi: 10.1186/s12889-020-09887-9.

Effectiveness of same-day antiretroviral therapy initiation in retention outcomes among people living with human immunodeficiency virus in Ethiopia: empirical evidence

Ismael Ahmed  1 , Meaza Demissie  2 , Alemayehu Worku  3 , Salem Gugsa  4 , Yemane Berhane  2
Affiliations
Multicenter Study

Effectiveness of same-day antiretroviral therapy initiation in retention outcomes among people living with human immunodeficiency virus in Ethiopia: empirical evidence

Ismael Ahmed et al. BMC Public Health. .

Abstract

Background: In August 2016, Ethiopia endorsed a universal "test and treat" strategy for people living with human immunodeficiency virus (PLHIV) based on World Health Organization recommendation. However, there is limited evidence on the routine application of the same-day "test and treat" recommendation in low-income settings. This study assessed the effect of same-day treatment initiation on individual-level retention at 6- and 12-months follow-up.

Methods: A multicenter facility-based retrospective cohort study was conducted to compare retention-in-care between PLHIV who started antiretroviral therapy (ART) on the same-day and those started ART > 7 days following HIV diagnoses. Participants were at least 15 years-old and were newly diagnosed and started on ART between October 2016 and July 2018 in 11 health facilities in the Amhara region of Ethiopia. Multivariable logistic regression controlling for potential confounders and Kaplan-Meier survival analysis were used to assess differences in outcomes between the groups.

Results: In total, 433 PLHIV started ART on the same-day of diagnosis and 555 PLHIV who started ART > 7 days after HIV diagnosis were included in the study. At 6-months, 82.0% (355) in the same-day group vs 89.4% (496) in the > 7 days group were retained-in-care (absolute risk difference (RD) = 7.4%; 95% confidence interval (CI): 2.9-11.8%). At 12-months, 75.8% (328) in the same-day group vs 82.0% (455) in the > 7 days group were retained-in-care (absolute RD = 6.2%; 95% CI: 1.1, 11.4%). The major drop in retention was in the first 30 days following ART initiation among same-day group. After adjusting for baseline and non-baseline covariates, the same-day group was less likely to be retained-in-care at 6- and 12-months (adjusted risk ratio (RR) = 0.89; 95% CI: 0.87, 0.90 and adjusted RR = 0.86; 95% CI: 0.83, 0.89, respectively).

Conclusions: Reduced retention-in-care can threaten the benefit of the same-day "test and treat" policy. The policy needs to be implemented cautiously with greater emphasis on assessment and preparation of PLHIV for ART to ensure treatment readiness before starting them on same-day ART and close monitoring of patients during early follow-up periods.

Keywords: Africa; Attrition; Ethiopia; Rapid ART; Retention; Same-day antiretroviral therapy; Test and treat.

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Conflict of interest statement

The authors declare that they have no competing interests.

Figures

Fig. 1
Fig. 1
Summary of number of participants and reasons for enrollment in the study
Fig. 2
Fig. 2
Survival plots based on Kaplan–Meier estimates comparing retention since ART initiation by study groups
See this image and copyright information in PMC

References

    1. Fox MP, Rosen S. Retention of Adult Patients on Antiretroviral Therapy in Low- And Middle-Income Countries: Systematic Review and Meta-analysis 2008–2013. J Acquir Immune Defic Syndr (1999). 2015; [cited 2020 Jun 2]. Available from: https://pubmed.ncbi.nlm.nih.gov/25942461/. - PMC - PubMed
    1. Fox MP, Rosen S. Patient retention in antiretroviral therapy programs up to three years on treatment in sub-Saharan Africa, 2007–2009: systematic review. Tropical Med Int Health. 2010;15:1–15. doi: 10.1111/j.1365-3156.2010.02508.x. - DOI - PMC - PubMed
    1. Biset Ayalew M. Mortality and its predictors among HIV infected patients taking antiretroviral treatment in Ethiopia: a systematic review. AIDS Res Treat. 2017;2017:5415298. - PMC - PubMed
    1. Gesesew HA, Ward P, Hajito KW, Feyissa GT, Mohammadi L, Mwanri L. Discontinuation from antiretroviral therapy: a continuing challenge among adults in HIV care in Ethiopia: a systematic review and meta-analysis. PLoS One. 2017;12:e0169651. doi: 10.1371/journal.pone.0169651. - DOI - PMC - PubMed
    1. Ayele W, Mulugeta A, Desta A, Rabito FA. Treatment outcomes and their determinants in HIV patients on anti-retroviral treatment program in selected health facilities of Kembata and Hadiya zones, southern nations, nationalities and peoples region, Ethiopia. BMC Public Health. 2015;15:826. doi: 10.1186/s12889-015-2176-5. - DOI - PMC - PubMed

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