Impact of universal antiretroviral treatment eligibility on rapid treatment initiation among young adolescents with HIV in sub-Saharan Africa.
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BORIS DOI
Date of Publication
August 4, 2020
Publication Type
Article
Division/Institute
Contributor
Tymejczyk, Olga | |
Brazier, Ellen | |
Wools-Kaloustian, Kara | |
Davies, Mary-Ann | |
DiLorenzo, Madeline | |
Edmonds, Andrew | |
Vreeman, Rachel | |
Bolton, Carolyn | |
Twizere, Christella | |
Okoko, Nicollate | |
Phiri, Sam | |
Nakigozi, Gertrude | |
Lelo, Patricia | |
Sohn, Annette H | |
Nash, Denis |
Series
Journal of infectious diseases
ISSN or ISBN (if monograph)
0022-1899
Publisher
Oxford University Press
Language
English
Publisher DOI
PubMed ID
31682261
Uncontrolled Keywords
Description
BACKGROUND
Young adolescents with perinatally-acquired HIV are at risk for poor care outcomes. We examined whether universal antiretroviral treatment (ART) eligibility policies (Treat All) improved rapid ART initiation following care enrollment among 10-14-year-olds in seven sub-Saharan African countries.
METHODS
Regression discontinuity analysis and data for 6,912 10-14-year-old patients were used to estimate changes in rapid ART initiation (within 30 days of care enrollment) following adoption of Treat All policies in two 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, compared with those adopting it in 2013: 23.4 percentage points (pp) (95%CI: 13.9-32.8) vs. 11.2pp (95%CI: 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 afterwards.
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.
Young adolescents with perinatally-acquired HIV are at risk for poor care outcomes. We examined whether universal antiretroviral treatment (ART) eligibility policies (Treat All) improved rapid ART initiation following care enrollment among 10-14-year-olds in seven sub-Saharan African countries.
METHODS
Regression discontinuity analysis and data for 6,912 10-14-year-old patients were used to estimate changes in rapid ART initiation (within 30 days of care enrollment) following adoption of Treat All policies in two 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, compared with those adopting it in 2013: 23.4 percentage points (pp) (95%CI: 13.9-32.8) vs. 11.2pp (95%CI: 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 afterwards.
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.
File(s)
| File | File Type | Format | Size | License | Publisher/Copright statement | Content | |
|---|---|---|---|---|---|---|---|
| Tymejczyk JInfectDis 2019_postprint.pdf | text | Adobe PDF | 1.1 MB | publisher | accepted | ||
| Tymejczyk JInfectDis 2020.pdf | text | Adobe PDF | 1.38 MB | publisher | published |