Regression discontinuity analysis demonstrated varied effect of Treat-All on CD4 testing among Southern African countries.
Antiretroviral therapy
CD4 lymphocyte count
HIV infection
Regression discontinuity design
Southern Africa
Viral load
Journal
Journal of clinical epidemiology
ISSN: 1878-5921
Titre abrégé: J Clin Epidemiol
Pays: United States
ID NLM: 8801383
Informations de publication
Date de publication:
12 2021
12 2021
Historique:
received:
23
06
2021
revised:
25
08
2021
accepted:
01
09
2021
pubmed:
7
9
2021
medline:
27
1
2022
entrez:
6
9
2021
Statut:
ppublish
Résumé
To determine whether Treat-All policy impacted laboratory testing practices of antiretroviral therapy (ART) programs in Southern Africa. We used HIV cohort data from Lesotho, Malawi, Mozambique, South Africa, Zambia and Zimbabwe in a regression discontinuity design to estimate changes in pre-ART CD4 testing and viral load monitoring following national Treat-all adoption that occurred during 2016 to 2017. This study included more than 230,000 ART-naïve people living with HIV (PLHIV) aged five years or older who started ART within two years of national Treat-All adoption. We found pre-ART CD4 testing decreased following adoption of Treat-All recommendations in Malawi (-21.4 percentage points (pp), 95% confidence interval, CI: -26.8, -16.0) and in Mozambique (-8.8pp, 95% CI: -14.9, -2.8), but increased in Zambia (+2.7pp, 95% CI: +0.4, +5.1). Treat-All policy had no effect on viral load monitoring, except among females in South Africa (+7.1pp, 95% CI: +1.1, +13.0). Treat-All policy expanded ART eligibility, but led to reductions in pre-ART CD4 testing in some countries that may weaken advanced HIV disease management. Continued and expanded support of CD4 and viral load laboratory capacity is needed to further improve treatment successes and allow for uniform evaluation of ART implementation across Southern Africa.
Identifiants
pubmed: 34487837
pii: S0895-4356(21)00281-X
doi: 10.1016/j.jclinepi.2021.09.001
pmc: PMC8712349
mid: NIHMS1744315
pii:
doi:
Substances chimiques
Anti-HIV Agents
0
Types de publication
Journal Article
Research Support, N.I.H., Extramural
Research Support, Non-U.S. Gov't
Langues
eng
Sous-ensembles de citation
IM
Pagination
101-110Subventions
Organisme : NIAID NIH HHS
ID : U01 AI069924
Pays : United States
Organisme : NIAID NIH HHS
ID : U01 AI096299
Pays : United States
Informations de copyright
Copyright © 2021 The Authors. Published by Elsevier Inc. All rights reserved.
Références
J Int AIDS Soc. 2019 Aug;22(8):e25387
pubmed: 31441242
MMWR Morb Mortal Wkly Rep. 2016 Dec 02;65(47):1332-1335
pubmed: 27906910
J Infect Dis. 2020 Aug 4;222(5):755-764
pubmed: 31682261
BMJ Open. 2020 May 15;10(5):e035246
pubmed: 32414825
J Int AIDS Soc. 2020 Jul;23(7):e25546
pubmed: 32640106
J Clin Epidemiol. 2017 Sep;89:21-29
pubmed: 28365303
J Int AIDS Soc. 2019 Jul;22(7):e25331
pubmed: 31623428
J Int AIDS Soc. 2018 Feb;21(2):
pubmed: 29479867
J Int AIDS Soc. 2015 Sep 23;18:20092
pubmed: 26403636
PLoS Med. 2017 Nov 28;14(11):e1002463
pubmed: 29182641
J Int AIDS Soc. 2018 Feb;21(2):
pubmed: 29436776
Int Health. 2017 Jul 1;9(4):206-214
pubmed: 28810670
Epidemiology. 2014 Sep;25(5):729-37
pubmed: 25061922
Curr Opin HIV AIDS. 2017 Mar;12(2):123-128
pubmed: 28059957
PLoS Med. 2019 Jun 10;16(6):e1002822
pubmed: 31181056
J Clin Epidemiol. 2015 Feb;68(2):122-33
pubmed: 25579639
J Virus Erad. 2018 Nov 15;4(Suppl 2):9-15
pubmed: 30515309
Clin Infect Dis. 2021 Sep 15;73(6):e1273-e1281
pubmed: 33693517
J Virus Erad. 2018 Nov 15;4(Suppl 2):5-8
pubmed: 30515308
PLoS Med. 2018 Mar 23;15(3):e1002534
pubmed: 29570723
J Clin Epidemiol. 2020 Dec;128:83-92
pubmed: 32828836
PLoS Med. 2018 Jun 5;15(6):e1002574
pubmed: 29870531
Curr HIV/AIDS Rep. 2019 Aug;16(4):304-313
pubmed: 31278620
J Clin Epidemiol. 2017 Sep;89:53-66
pubmed: 28365306