Decreasing time to antiretroviral therapy initiation after HIV diagnosis in a clinic-based observational cohort study in four African countries.

Adult Anti-HIV Agents / therapeutic use Cohort Studies Female HIV Infections / diagnosis Humans Kenya Male Nigeria Proportional Hazards Models Tanzania Time-to-Treatment Uganda
Africa CD4 lymphocyte count HIV-1 antiretroviral therapy highly active time-to-treatment treatment initiation

Journal

Journal of the International AIDS Society
ISSN: 1758-2652
Titre abrégé: J Int AIDS Soc
Pays: Switzerland
ID NLM: 101478566

Informations de publication

Date de publication:
02 2020
Historique:
received: 28 08 2019
revised: 06 12 2019
accepted: 16 12 2019
entrez: 18 2 2020
pubmed: 18 2 2020
medline: 5 11 2020
Statut: ppublish

Résumé

World Health Organization (WHO) guidelines have shifted over time to recommend earlier initiation of antiretroviral therapy (ART) and now encourage ART initiation on the day of HIV diagnosis, if possible. However, barriers to ART access may delay initiation in resource-limited settings. We characterized temporal trends and other factors influencing the interval between HIV diagnosis and ART initiation among participants enrolled in a clinic-based cohort across four African countries. The African Cohort Study enrols adults engaged in care at 12 sites in Uganda, Kenya, Tanzania and Nigeria. Participants provide a medical history, complete a physical examination and undergo laboratory assessments every six months. Participants with recorded dates of HIV diagnosis were categorized by WHO guideline era (<2006, 2006 to 2009, 2010 to 2012, 2013 to 2015, ≥2016) at the time of diagnosis. Cox proportional hazard modelling was used to estimate hazard ratios (HRs) and 95% confidence intervals (95% CI) for time to ART initiation. From January 2013 to September 2019, a total of 2888 adults living with HIV enrolled with known diagnosis dates. Median time to ART initiation decreased from 22.0 months (interquartile range (IQR) 4.0 to 77.3) among participants diagnosed prior to 2006 to 0.5 months (IQR 0.2 to 1.8) among those diagnosed in 2016 and later. Comparing those same periods, CD4 nadir increased from a median of 166 cells/mm Consistent with changing guidelines, the interval between diagnosis and ART initiation has decreased over time. Still, many adults living with HIV initiated treatment with low CD4, highlighting the need to diagnose HIV earlier while improving access to immediate ART after diagnosis.

Identifiants

DOI: 10.1002/jia2.25446 PMID: 32064776 PMC: PMC7025087
pubmed: 32064776
doi: 10.1002/jia2.25446
pmc: PMC7025087
doi:

Substances chimiques

Anti-HIV Agents 0

Types de publication

Journal Article Research Support, Non-U.S. Gov't Research Support, U.S. Gov't, Non-P.H.S.

Langues

eng

Sous-ensembles de citation

IM

Pagination

e25446

Subventions

Organisme : PEPFAR
Pays : United States

Investigateurs

A Parikh (A)
J Hern (J)
O Falodun (O)
K Song (K)
M Milazzo (M)
N Dear (N)
L Francisco (L)
S Mankiewicz (S)
S Schech (S)
A Golway (A)
T Mebrahtu (T)
E Lee (E)
K Bohince (K)
T Hamm (T)
K Lombardi (K)
M Imbach (M)
L Eller (L)
S Peel (S)
J Malia (J)
A Kroidl (A)
I Kroidl (I)
C Geldmacher (C)
C Kafeero (C)
A Nambuya (A)
J Tegamanyi (J)
H Birungi (H)
O Mugagga (O)
G Nassali (G)
P Wangiri (P)
M Nantabo (M)
P Nambulondo (P)
B Atwijuka (B)
A Asiimwe (A)
C T Nabanoba (CT)
M Semwogerere (M)
R Mwesigwa (R)
S Jjuuko (S)
R Namagembe (R)
E Bagyendagye (E)
A Tindikahwa (A)
I Rwomushana (I)
F Ssentongo (F)
H Kibuuka (H)
M Millard (M)
J Kapkiai (J)
S Wangare (S)
R Mangesoi (R)
P Chepkwony (P)
L Bor (L)
E Maera (E)
A Kasembeli (A)
J Rotich (J)
C Kipkoech (C)
W Chepkemoi (W)
A Rono (A)
Zeddy Kesi (Z)
Janet Ngeno (J)
Edwin Langat (E)
Keneddy Labosso (K)
Ken Langat (K)
Robert Kirui (R)
L Rotich (L)
M Mabwai (M)
E Chelangat (E)
J Agutu (J)
C Tonui (C)
E Changwony (E)
M Bii (M)
E Chumba (E)
J Korir (J)
J Sugut (J)
D Gitonga (D)
R Ngetich (R)
S Kiprotich (S)
W Rehema (W)
C Ogari (C)
I Ouma (I)
O Adimo (O)
S Ogai (S)
C Okwaro (C)
E Maranga (E)
J Ochola (J)
K Obambo (K)
V Sing'oei (V)
L Otieno (L)
O Nyapiedho (O)
N Sande (N)
E Odemba (E)
F Wanjiru (F)
S Khamadi (S)
E Chiweka (E)
A Lwilla (A)
D Mkondoo (D)
N Somi (N)
P Kiliba (P)
M Nwando (M)
G Mwaisanga (G)
J Muhumuza (J)
N Mkingule (N)
O Mwasulama (O)
A Sanagare (A)
P Kishimbo (P)
G David (G)
F Mbwayu (F)
J Mwamwaja (J)
J Likiliwike (J)
J Muhumuza (J)
R Mcharo (R)
N Mkingule (N)
O Mwasulama (O)
B Mtafya (B)
C Lueer (C)
A Kisinda (A)
T Mbena (T)
H Mfumbulwa (H)
L Mwandumbya (L)
P Edwin (P)
W Olomi (W)
Y Adamu (Y)
A Akintunde (A)
A B Tiamiyu (AB)
K Afoke (K)
S Mohammed (S)
N E Harrison (NE)
U C Agbaim (UC)
O A Adegbite (OA)
Z Parker (Z)
G A Adelakun (GA)
F O Oni (FO)
R O Ndbuisi (RO)
J Elemere (J)
N Azuakola (N)
T T Williams (TT)
M Ayogu (M)
O Enas (O)
O Enameguono (O)
A F Odo (AF)
I C Ukaegbu (IC)
O Ugwuezumba (O)
S O Odeyemi (SO)
N C Okeke (NC)
L Umeji (L)
A Rose (A)
H Daniel (H)
H Nwando (H)
E I Nicholas (EI)
T Iyanda (T)
C Okolo (C)
V Y Mene (VY)
B Dogonyaro (B)
O Olabulo (O)
O Akinseli (O)
F Onukun (F)
G Knopp (G)

Informations de copyright

© 2020 Henry M Foundation for the Advancement of Military Medicine. Journal of the International AIDS Society published by John Wiley & Sons Ltd on behalf of the International AIDS Society.

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Auteurs

Allahna L Esber (AL)

U.S. Military HIV Research Program, Walter Reed Army Institute of Research, Silver Spring, MD, USA.
Henry M. Jackson Foundation for the Advancement of Military Medicine, Bethesda, MD, USA.
ORCID: 0000-0001-5337-0126

Peter Coakley (P)

U.S. Military HIV Research Program, Walter Reed Army Institute of Research, Silver Spring, MD, USA.
Henry M. Jackson Foundation for the Advancement of Military Medicine, Bethesda, MD, USA.

Julie A Ake (JA)

U.S. Military HIV Research Program, Walter Reed Army Institute of Research, Silver Spring, MD, USA.

Emmanuel Bahemana (E)

U.S. Military HIV Research Program, Walter Reed Army Institute of Research, Silver Spring, MD, USA.
Henry Jackson Foundation MRI, Mbeya, Tanzania.

Yakubu Adamu (Y)

U.S. Military HIV Research Program, Walter Reed Army Institute of Research, Silver Spring, MD, USA.
U.S. Army Medical Research Directorate - Africa, Nairobi, Kenya.
Henry Jackson Foundation MRI, Abuja, Nigeria.

Francis Kiweewa (F)

Makerere University Walter Reed Project, Kampala, Uganda.
ORCID: 0000-0003-4938-9558

Jonah Maswai (J)

U.S. Military HIV Research Program, Walter Reed Army Institute of Research, Silver Spring, MD, USA.
Kenya Medical Research Institute/U.S. Army Medical Research Directorate, Nairobi, Kenya.
Henry Jackson Foundation MRI, Kericho, Kenya.

John Owuoth (J)

U.S. Military HIV Research Program, Walter Reed Army Institute of Research, Silver Spring, MD, USA.
Kenya Medical Research Institute/U.S. Army Medical Research Directorate, Nairobi, Kenya.
Henry Jackson Foundation MRI, Kisumu, Kenya.

Merlin L Robb (ML)

U.S. Military HIV Research Program, Walter Reed Army Institute of Research, Silver Spring, MD, USA.
Henry M. Jackson Foundation for the Advancement of Military Medicine, Bethesda, MD, USA.

Christina S Polyak (CS)

U.S. Military HIV Research Program, Walter Reed Army Institute of Research, Silver Spring, MD, USA.
Henry M. Jackson Foundation for the Advancement of Military Medicine, Bethesda, MD, USA.

Trevor A Crowell (TA)

U.S. Military HIV Research Program, Walter Reed Army Institute of Research, Silver Spring, MD, USA.
Henry M. Jackson Foundation for the Advancement of Military Medicine, Bethesda, MD, USA.
ORCID: 0000-0001-5947-265X

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Classifications MeSH

questionsmedicales.fr › Personnes › Tranches d'âge › Adulte › Decreasing time to antiretroviral therapy...
questionsmedicales.fr › Actions chimiques et utilisations › Actions pharmacologiques › Utilisations thérapeutiques › Anti-infectieux › Antiviraux › Antirétroviraux › Agents antiVIH › Decreasing time to antiretroviral therapy...
questionsmedicales.fr › Environnement et santé publique › Santé publique › Méthodes épidémiologiques › Caractéristiques des études épidémiologiques › Études épidémiologiques › Études de cohortes › Decreasing time to antiretroviral therapy...
questionsmedicales.fr › Maladies du système immunitaire › Déficits immunitaires › Infections à VIH › Decreasing time to antiretroviral therapy...
questionsmedicales.fr › Eucaryotes › Animaux › Chordés › Vertébrés › Mammifères › Eutheria › Primates › Haplorhini › Catarrhini › Hominidae › Humains › Decreasing time to antiretroviral therapy...
questionsmedicales.fr › Régions géographiques › Afrique › Afrique subsaharienne › Afrique de l'Est › Kenya › Decreasing time to antiretroviral therapy...
questionsmedicales.fr › Régions géographiques › Afrique › Afrique subsaharienne › Afrique de l'Ouest › Nigeria › Decreasing time to antiretroviral therapy...
questionsmedicales.fr › Environnement et santé publique › Santé publique › Méthodes épidémiologiques › Statistiques comme sujet › Analyse de survie › Modèles des risques proportionnels › Decreasing time to antiretroviral therapy...
questionsmedicales.fr › Régions géographiques › Afrique › Afrique subsaharienne › Afrique de l'Est › Tanzanie › Decreasing time to antiretroviral therapy...
questionsmedicales.fr › Établissements, main d'oeuvre et services de soins de santé › Services de santé › Soins aux patients › Délai jusqu'au traitement › Decreasing time to antiretroviral therapy...
questionsmedicales.fr › Régions géographiques › Afrique › Afrique subsaharienne › Afrique de l'Est › Ouganda › Decreasing time to antiretroviral therapy...