Better Outcomes Among HIV-Infected Rwandan Children 18–60 Months of Age After the Implementation of "Treat All". (1st March 2019)

• Record Type: Journal Article
• Authors: Arpadi, Stephen; Lamb, Matthew; Nzeyimana, Isaie N.; Vandebriel, Greet; Anyalechi, Gloria; Wong, Marcia; Smith, Rebecca; Rivadeneira, Emilia D.; Kayirangwa, Eugenie; Malamba, Samuel S.; Musoni, Canisious; Koumans, Emilia H.; Braaten, Mollie; Nsanzimana, Sabin
• Is Part Of: Journal of acquired immune deficiency syndromes. Volume 80:Number 3(2019)
• Publication Date: 2019-03-01
• Subjects: children -- antiretroviral therapy -- HIV -- Treat All; AIDS (Disease) -- Periodicals; Acquired Immunodeficiency Syndrome -- Periodicals; AIDS (Disease); Periodicals; 616.9792005
• DOI: 10.1097/QAI.0000000000001907
• Languages: English
• ISSNs: 1525-4135

Abstract

Abstract : Background: In 2012, Rwanda introduced a Treat All approach for HIV-infected children younger than 5 years. We compared antiretroviral therapy (ART) initiation, outcomes, and retention, before and after this change. Methods: We conducted a retrospective study of children enrolled into care between June 2009 and December 2011 [Before Treat All (BTA) cohort] and between July 2012 and April 2015 [Treat All (TA) cohort]. Setting: Medical records of a nationally representative sample were abstracted for all eligible aged 18–60 months from 100 Rwandan public health facilities. Results: We abstracted 374 medical records: 227 in the BTA and 147 in the TA cohorts. Mean (SD) age at enrollment was [3 years (1.1)]. Among BTA, 59% initiated ART within 1 year, vs. 89% in the TA cohort. Median time to ART initiation was 68 days (interquartile range 14–494) for BTA and 9 days (interquartile range 0–28) for TA ( P < 0.0001), with 9 (5%) undergoing same-day initiation in BTA compared with 50 (37%) in TA ( P < 0.0001). Before ART initiation, 59% in the BTA reported at least one health condition compared with 35% in the TA cohort ( P < 0.0001). Although overall loss to follow-up was similar between cohorts (BTA: 13%, TA: 8%, P = 0.18), loss to follow-up before ART was significantly higher in the BTA (8%) compared with the TA cohort (2%) ( P = 0.02). Conclusions: Nearly 90% of Rwandan children started on ART within 1 year of enrollment, most within 1 month, with greater than 90% retention after implementation of TA. TA was also associated with fewer morbidities.