Author | Brazier, Ellen | |
Author | Tymejczyk, Olga | |
Author | Zaniewski, Elizabeth | |
Author | Egger, Matthias | |
Author | Wools-Kaloustian, Kara | |
Author | Yiannoutsos, Constantin T. | |
Author | Jaquet, Antoine | |
Author | Althoff, Keri N. | |
Author | Lee, Jennifer S. | |
Author | Caro-Vega, Yanink | |
Author | Luz, Paula M. | |
Author | Tanuma, Junko | |
Author | Niyongabo, Théodore | |
Author | Nash, Denis | |
Access date | 2021-12-20T23:49:23Z | |
Available date | 2021-12-20T23:49:23Z | |
Document date | 2021 | |
Citation | BRAZIER, Ellen et al. Effects of National Adoption of Treat-All Guidelines on Pre-Antiretroviral Therapy (ART) CD4 Testing and Viral Load Monitoring After ART initiation: A Regression Discontinuity Analysis. Clinical infectious diseases, v. 73, n. 6, p. 1273-1281, 2021 | pt_BR |
ISSN | 1058-4838 | pt_BR |
URI | https://www.arca.fiocruz.br/handle/icict/50493 | |
Language | eng | pt_BR |
Publisher | Oxford | pt_BR |
Rights | restricted access | pt_BR |
Title | Effects of National Adoption of Treat-All Guidelines on Pre-Antiretroviral Therapy (ART) CD4 Testing and Viral Load Monitoring After ART initiation: A Regression Discontinuity Analysis | pt_BR |
Type | Article | pt_BR |
DOI | 10.1093/cid/ciab222 | |
Abstract | Background: The World Health Organization's Treat-All guidance recommends CD4 testing before initiating antiretroviral therapy (ART), and routine viral load (VL) monitoring (over CD4 monitoring) for patients on ART.
Methods: We used regression discontinuity analyses to estimate changes in CD4 testing and VL monitoring among 547 837 ART-naive patients enrolling in human immunodeficiency virus (HIV) care during 2006-2018 at 225 clinics in 26 countries where Treat-All policies were adopted. We examined CD4 testing within 12 months before and VL monitoring 6 months after ART initiation among adults (≥20 years), adolescents (10-19 years), and children (0-9 years) in low/lower-middle-income countries (L/LMICs) and high/upper-middle-income countries (H/UMICs).
Results: Treat-All adoption led to an immediate decrease in pre-ART CD4 testing among adults in L/LMICs, from 57.0% to 48.1% (-8.9 percentage points [pp]; 95% CI: -11.0, -6.8), and a small increase in H/UMICs, from 90.1% to 91.7% (+1.6pp; 95% CI: 0.2, 3.0), with no changes among adolescents or children; decreases in pre-ART CD4 testing accelerated after Treat-All adoption in L/LMICs. In L/LMICs, VL monitoring after ART initiation was low among all patients in L/LMICs before Treat-All; while there was no immediate change at Treat-All adoption, VL monitoring trends significantly increased afterwards. VL monitoring increased among adults immediately after Treat-All adoption, from 58.2% to 61.1% (+2.9pp; 95% CI: 0.5, 5.4), with no significant changes among adolescents/children.
Conclusions: While on-ART VL monitoring has improved in L/LMICs, Treat-All adoption has accelerated and disparately worsened suboptimal pre-ART CD4 monitoring, which may compromise care outcomes for individuals with advanced HIV. | pt_BR |
Affilliation | City University of New York. Graduate School of Public Health and Health Policy. Institute for Implementation Science in Population Health. New York, NY, USA. | pt_BR |
Affilliation | City University of New York. Graduate School of Public Health and Health Policy. Institute for Implementation Science in Population Health. New York, NY, USA. | pt_BR |
Affilliation | University of Bern. Institute of Social and Preventive Medicine. Bern, Switzerland. | pt_BR |
Affilliation | University of Bern. Institute of Social and Preventive Medicine. Bern, Switzerland. | pt_BR |
Affilliation | Indiana University. School of Medicine. Indianapolis, Indiana, USA. | pt_BR |
Affilliation | Indiana University. R. M. Fairbanks School of Public Health. Department of Biostatistics. Indianapolis, Indiana, USA. | pt_BR |
Affilliation | University of Bordeaux. French National Research Institute for Sustainable Development. Bordeaux, France. | pt_BR |
Affilliation | Johns Hopkins Bloomberg School of Public Health. Department of Epidemiology. Baltimore, Maryland, USA. | pt_BR |
Affilliation | Johns Hopkins Bloomberg School of Public Health. Department of Epidemiology. Baltimore, Maryland, USA. | pt_BR |
Affilliation | Instituto Nacional de Ciencias Médicas y Nutrición "Salvador Zubirán". Departamento de Infectología. Mexico City, Mexico. | pt_BR |
Affilliation | Fundação Oswaldo Cruz. Instituto Nacional de Infectologia Evandro Chagas. Laboratório de Pesquisa Clínica em DST/AIDS. Rio de Janeiro, RJ, Brasil. | pt_BR |
Affilliation | National Center for Global Health and Medicine. AIDS Clinical Center. Tokyo, Japan. | pt_BR |
Affilliation | Centre National de Reference en Matière de VIH/SIDA. Bujumbura, Burundi. | pt_BR |
Affilliation | City University of New York. Graduate School of Public Health and Health Policy. Institute for Implementation Science in Population Health. New York, NY, USA. | pt_BR |
Subject | HIV care | pt_BR |
Subject | Treat-All | pt_BR |
Subject | pre-ART CD4 testing | pt_BR |
Subject | Viral load monitoring | pt_BR |