Toward Universal HIV Treatment in Haiti: Time Trends in ART Retention After Expanded ART Eligibility in a National Cohort From 2011 to 2017. (1st June 2020)

• Record Type: Journal Article
• Authors: Puttkammer, Nancy; Parrish, Canada; Desir, Yrvel; Hyppolite, Nathaelf; Wagenaar, Bradley H.; Joseph, Nadjy; Hall, Lara; Honoré, Jean Guy; Robin, Ermane; Perrin, Georges; François, Kesner
• Is Part Of: Journal of acquired immune deficiency syndromes. Volume 84:Number 2(2020)
• Publication Date: 2020-06-01
• Subjects: ART -- Haiti -- universal treatment -- same-day treatment -- ART retention -- implementation science; AIDS (Disease) -- Periodicals; Acquired Immunodeficiency Syndrome -- Periodicals; AIDS (Disease); Periodicals; 616.9792005
• DOI: 10.1097/QAI.0000000000002329
• Languages: English
• ISSNs: 1525-4135

Abstract

Abstract : Background: The World Health Organization (WHO) recommends universal antiretroviral therapy (ART) for persons living with HIV (PLWH), but evidence about effects of expanded ART access on ART retention in low-resource settings is limited. Setting: Haiti's Ministry of Health endorsed universal ART for pregnant women in March 2013 (Option B+) and for all PLWH in July 2016. This study included 51, 579 ART patients from 2011 to 2017 at 94 hospitals and clinics in Haiti. Methods: This observational, retrospective cohort study described time trends in 6-month ART retention using secondary data, and compared results during 3 periods using an interrupted time series model: pre-Option B+ (period 1: 1/11–2/13), Option B+ (period 2: 3/13–6/16), and Test and Start (T&S, period 3: 7/16–9/17). Results: From the pre-Option B+ to the T&S period, the monthly count of new ART patients increased from 366/month to 877/month, and the proportion with same-day ART increased from 6.3% to 42.1% ( P < 0.001). The proportion retained on ART after 6 months declined from 78.4% to 75.0% ( P < 0.001). In the interrupted time series model, ART retention improved by a rate of 1.4% per quarter during the T&S period after adjusting for patient characteristics (adjusted incidence rate ratio = 1.014; 95% confidence interval: 1.002 to 1.026, P < 0.001). However, patients with same-day ART were 14% less likely to be retained compared to those starting ART >30 days after HIV diagnosis (adjusted incidence rate ratio = 0.86; 95% confidence interval: 0.84–0.89, P < 0.001). Conclusions: Achieving targets for HIV epidemic control will require increasing ART retention and reducing the disparity in retention for those with same-day ART. Abstract : Supplemental Digital Content is Available in the Text.