Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2023 Sep 5;23(1):1724.
doi: 10.1186/s12889-023-16353-9.

Understanding the effects of universal test and treat on longitudinal HIV care outcomes among South African youth: a retrospective cohort study

Lindsey M Filiatreau  1 , Jessie K Edwards  2 , Nkosinathi Masilela  3 , F Xavier Gómez-Olivé  3 , Nicole Haberland  4 , Brian W Pence  2 , Joanna Maselko  2 , Kathryn E Muessig  5 , Chodziwadziwa Whiteson Kabudula  3 , Mi-Suk Kang Dufour  6 , Sheri A Lippman  3   7 , Kathleen Kahn  3 , Audrey Pettifor  2   3   8
Affiliations

Understanding the effects of universal test and treat on longitudinal HIV care outcomes among South African youth: a retrospective cohort study

Lindsey M Filiatreau et al. BMC Public Health. .

Abstract

Introduction: Little is known about the effects of universal test and treat (UTT) policies on HIV care outcomes among youth living with HIV (YLHIV). Moreover, there is a paucity of information regarding when YLHIV are most susceptible to disengagement from care under the newest treatment guidelines. The longitudinal HIV care continuum is an underutilized tool that can provide a holistic understanding of population-level HIV care trajectories and be used to compare treatment outcomes across groups. We aimed to explore effects of the UTT policy on longitudinal outcomes among South African YLHIV and identify temporally precise opportunities for re-engaging this priority population in the UTT era.

Methods: Using medical record data, we conducted a retrospective cohort study among youth aged 18-24 diagnosed with HIV from August 2015-December 2018 in nine health care facilities in South Africa. We used Fine and Gray sub-distribution proportional hazards models to characterize longitudinal care continuum outcomes in the population overall and stratified by treatment era of diagnosis. We estimated the proportion of individuals in each stage of the continuum over time and the restricted mean time spent in each stage in the first year following diagnosis. Sub-group estimates were compared using differences.

Results: A total of 420 YLHIV were included. By day 365 following diagnosis, just 23% of individuals had no 90-or-more-day lapse in care and were virally suppressed. Those diagnosed in the UTT era spent less time as ART-naïve (mean difference=-19.3 days; 95% CI: -27.7, -10.9) and more time virally suppressed (mean difference = 17.7; 95% CI: 1.0, 34.4) compared to those diagnosed pre-UTT. Most individuals who were diagnosed in the UTT era and experienced a 90-or-more-day lapse in care disengaged between diagnosis and linkage to care or ART initiation and viral suppression.

Conclusions: Implementation of UTT yielded modest improvements in time spent on ART and virally suppressed among South African YLHIV- however, meeting UNAIDS' 95-95-95 targets remains a challenge. Retention in care and re-engagement interventions that can be implemented between diagnosis and linkage to care and between ART initiation and viral suppression (e.g., longitudinal counseling) may be particularly important to improving care outcomes among South African YLHIV in the UTT era.

Keywords: HIV care continuum; Linkage to care; Retention in care; South Africa; Universal test and treat; Viral suppression; Youth living with HIV.

PubMed Disclaimer

Conflict of interest statement

Funding acknowledgments are listed below under the “Funding” section. The authors declare that they have no other competing interests.

Figures

Fig. 1
Fig. 1
Conceptual framework for flow (arrows) through the longitudinal HIV care continuum stages (boxes) Abbreviations: ART-antiretroviral treatment initiation; LTFU- loss to follow-up
Fig. 2
Fig. 2
Cumulative incidence of HIV care outcomes over 1-year following diagnosis, stratified by treatment era of diagnosis Abbreviations: ART- antiretroviral treatment; LTFU- lost to follow-up; UTT- Universal Test and Treat Weighted to account for differences in age at diagnosis and sex by era of diagnosis
See this image and copyright information in PMC

References

    1. Ehrenkranz P, Rosen S, Boulle A, Eaton JW, Ford N, Fox MP, et al. The revolving door of HIV care: revising the service delivery cascade to achieve the UNAIDS 95-95-95 goals. PLoS Med. 2021 May;18(5):e1003651. - PMC - PubMed
    1. Jose S, Delpech V, Howarth A, Burns F, Hill T, Porter K, et al. A continuum of HIV care describing mortality and loss to follow-up: a longitudinal cohort study. Lancet HIV. 2018 Jun;5(6):e301–8. - PMC - PubMed
    1. Mody A, Glidden D v, Eshun-Wilson I, Sikombe K, Simbeza S, Mukamba N, et al. Longitudinal Care cascade outcomes among people eligible for antiretroviral therapy who are newly linking to care in Zambia: a multistate analysis. Clin Infect Dis. 2020 Dec;71(10):e561–70. - PMC - PubMed
    1. Beer L, Mattson CL, Bradley H, Shouse RL. Trends in ART prescription and viral suppression among HIV-positive young adults in care in the United States, 2009-2013. J Acquir Immune Defic Syndr (1988). 2017 Sep;76(1):e1–6. - PMC - PubMed
    1. Lee S, Kapogiannis BG, Allison S. Improving the youth HIV prevention and care continuums: the adolescent medicine trials network for HIV/AIDS interventions. JMIR Res Protoc. 2019 Mar;8(3):e12050. - PMC - PubMed

Publication types