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. 2023 Jan 6;76(1):39-47.
doi: 10.1093/cid/ciac759.

Same-Day Antiretroviral Therapy Initiation as a Predictor of Loss to Follow-up and Viral Suppression Among People With Human Immunodeficiency Virus in Sub-Saharan Africa

Jonathan Ross  1   2 , Ellen Brazier  3   4 , Geoffrey Fatti  5   6 , Antoine Jaquet  7 , Aristophane Tanon  8 , Andreas D Haas  9 , Lameck Diero  10 , Barbara Castelnuovo  10 , Constantin T Yiannoutsos  11 , Denis Nash  3   4 , Kathryn M Anastos  1   2 , Marcel Yotebieng  1   2
Affiliations

Same-Day Antiretroviral Therapy Initiation as a Predictor of Loss to Follow-up and Viral Suppression Among People With Human Immunodeficiency Virus in Sub-Saharan Africa

Jonathan Ross et al. Clin Infect Dis. .

Abstract

Background: Treat-All guidelines recommend initiation of antiretroviral therapy (ART) for all people with HIV (PWH) on the day of diagnosis when possible, yet uncertainty exists about the impact of same-day ART initiation on subsequent care engagement. We examined the association of same-day ART initiation with loss to follow-up and viral suppression among patients in 11 sub-Saharan African countries.

Methods: We included ART-naive adult PWH from sites participating in the International epidemiology Databases to Evaluate AIDS (IeDEA) consortium who enrolled in care after Treat-All implementation and prior to January 2019. We used multivariable Cox regression to estimate the association between same-day ART initiation and loss to follow-up and Poisson regression to estimate the association between same-day ART initiation and 6-month viral suppression.

Results: Among 29 017 patients from 63 sites, 18 584 (64.0%) initiated ART on the day of enrollment. Same-day ART initiation was less likely among those with advanced HIV disease versus early-stage disease. Loss to follow-up was significantly lower among those initiating ART ≥1 day of enrollment, compared with same-day ART initiators (20.6% vs 27.7%; adjusted hazard ratio: .66; 95% CI .57-.76). No difference in viral suppression was observed by time to ART initiation (adjusted rate ratio: 1.00; 95% CI: .98-1.02).

Conclusions: Patients initiating ART on the day of enrollment were more frequently lost to follow-up than those initiating later but were equally likely to be virally suppressed. Our findings support recent World Health Organization recommendations for providing tailored counseling and support to patients who accept an offer of same-day ART.

Keywords: Treat-All; antiretroviral therapy; loss to follow-up; sub-Saharan Africa.

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Conflict of interest statement

Potential conflicts of interest. D. N. received research support from Pfizer, Inc; payment or honoraria for lectures, presentations, speaker’s bureaus, manuscript writing, or educational events from various academic lectures at universities (paid to author); and consulting fees from Epidemic Intelligence, LLC, and Medscape. J. R. reports payment or honoraria for lectures, presentations, speaker’s bureaus, manuscript writing, or educational events for Grand Rounds speaker in 2019 (paid to author). E. B. reports support from the National Institutes of Health (NIH). G. F. reports support from International Epidemiologic Databases to Evaluate AIDS–Southern Africa, using funding provided by the NIH (funding provided to Kheth’Impilo AIDS Free Living [nonprofit]). B. C. reports support from NIH (D43 TW 009771: names of PD/Principal Investigators: Castelnuovo/Kambugu/Manabe) and the European & Developing Countries Clinical Trials Partnership (TWA 2017GSF-1936: Castelnuovo). C. T. Y. and K. M. A. report grants or contracts and support for attending meetings and/or travel from NIH (paid to institution). M. Y. reports grants or contracts from NIH: U01AI096299, R01HD087993, R01HD105526, and U54CA254568. All other authors report no potential conflicts. All authors have submitted the ICMJE Form for Disclosure of Potential Conflicts of Interest. Conflicts that the editors consider relevant to the content of the manuscript have been disclosed.

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