Olga Tymejczyk1, Ellen Brazier1, Kara Wools-Kaloustian2, Mary-Ann Davies3, Madeline Dilorenzo1,4, Andrew Edmonds5, Rachel Vreeman6, Carolyn Bolton7, Christella Twizere8, Nicollate Okoko9, Sam Phiri10, Gertrude Nakigozi11, Patricia Lelo12, Per von Groote13, Annette H Sohn14, Denis Nash1,15. 1. Institute for Implementation Science in Population Health, City University of New York, New York, NY, USA. 2. Indiana University School of Medicine, Indianapolis, Indiana, USA. 3. Centre for Infectious Disease Epidemiology and Research, School of Public Health and Family Medicine, University of Cape Town, Cape Town, South Africa. 4. Boston Medical Center, Boston, Massachusetts, USA. 5. Department of Epidemiology, The University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA. 6. Department of Pediatrics, Indiana University School of Medicine, Indianapolis, Indiana, USA. 7. Centre for Infectious Disease Research in Zambia, Lusaka, Zambia. 8. Centre Hospitalo-Universitaire de Kamenge, Bujumbura, Burundi. 9. Kenya Medical Research Institute (KEMRI), Nairobi, Kenya. 10. Lighthouse Trust, Lilongwe, Malawi. 11. Rakai Health Sciences Program, Kalisizo, Uganda. 12. Kalembelembe Pediatric Hospital, Kinshasa, Democratic Republic of the Congo. 13. Institute of Social and Preventive Medicine, University of Bern, Bern, Switzerland. 14. TREAT Asia, amfAR-The Foundation for AIDS Research, Bangkok, Thailand. 15. Department of Epidemiology and Biostatistics, School of Public Health, City University of New York, New York, NY, USA.
Abstract
BACKGROUND: Young adolescents with perinatally acquired human immunodeficiency virus (HIV) are at risk for poor care outcomes. We examined whether universal antiretroviral treatment (ART) eligibility policies (Treat All) improved rapid ART initiation after care enrollment among 10-14-year-olds in 7 sub-Saharan African countries. METHODS: Regression discontinuity analysis and data for 6912 patients aged 10-14-years were used to estimate changes in rapid ART initiation (within 30 days of care enrollment) after adoption of Treat All policies in 2 groups of countries: Uganda and Zambia (policy adopted in 2013) and Burundi, Democratic Republic of the Congo, Kenya, Malawi, and Rwanda (policy adopted in 2016). RESULTS: There were immediate increases in rapid ART initiation among young adolescents after national adoption of Treat All. Increases were greater in countries adopting the policy in 2016 than in those adopting it in 2013: 23.4 percentage points (pp) (95% confidence interval, 13.9-32.8) versus 11.2pp (2.5-19.9). However, the rate of increase in rapid ART initiation among 10-14-year-olds rose appreciably in countries with earlier treatment expansions, from 1.5pp per year before Treat All to 7.7pp per year afterward. CONCLUSIONS: Universal ART eligibility has increased rapid treatment initiation among young adolescents enrolling in HIV care. Further research should assess their retention in care and viral suppression under Treat All.
BACKGROUND: Young adolescents with perinatally acquired human immunodeficiency virus (HIV) are at risk for poor care outcomes. We examined whether universal antiretroviral treatment (ART) eligibility policies (Treat All) improved rapid ART initiation after care enrollment among 10-14-year-olds in 7 sub-Saharan African countries. METHODS: Regression discontinuity analysis and data for 6912 patients aged 10-14-years were used to estimate changes in rapid ART initiation (within 30 days of care enrollment) after adoption of Treat All policies in 2 groups of countries: Uganda and Zambia (policy adopted in 2013) and Burundi, Democratic Republic of the Congo, Kenya, Malawi, and Rwanda (policy adopted in 2016). RESULTS: There were immediate increases in rapid ART initiation among young adolescents after national adoption of Treat All. Increases were greater in countries adopting the policy in 2016 than in those adopting it in 2013: 23.4 percentage points (pp) (95% confidence interval, 13.9-32.8) versus 11.2pp (2.5-19.9). However, the rate of increase in rapid ART initiation among 10-14-year-olds rose appreciably in countries with earlier treatment expansions, from 1.5pp per year before Treat All to 7.7pp per year afterward. CONCLUSIONS: Universal ART eligibility has increased rapid treatment initiation among young adolescents enrolling in HIV care. Further research should assess their retention in care and viral suppression under Treat All.
Authors: Jacob Bor; Matthew P Fox; Sydney Rosen; Atheendar Venkataramani; Frank Tanser; Deenan Pillay; Till Bärnighausen Journal: PLoS Med Date: 2017-11-28 Impact factor: 11.613
Authors: Cristin Q Fritz; Meridith Blevins; Mary Lou Lindegren; Kara Wools-Kaloutsian; Beverly S Musick; Morna Cornell; Kelly Goodwin; Dianne Addison; Jean Claude Dusingize; Eugène Messou; Armel Poda; Stephany N Duda; Catherine C McGowan; Matthew G Law; Richard D Moore; Aimee Freeman; Denis Nash; C William Wester Journal: J Int AIDS Soc Date: 2017-01-06 Impact factor: 5.396
Authors: Amy L Slogrove; Michael Schomaker; Mary-Ann Davies; Paige Williams; Suna Balkan; Jihane Ben-Farhat; Nancy Calles; Kulkanya Chokephaibulkit; Charlotte Duff; Tanoh François Eboua; Adeodata Kekitiinwa-Rukyalekere; Nicola Maxwell; Jorge Pinto; George Seage; Chloe A Teasdale; Sebastian Wanless; Josiane Warszawski; Kara Wools-Kaloustian; Marcel Yotebieng; Venessa Timmerman; Intira J Collins; Ruth Goodall; Colette Smith; Kunjal Patel; Mary Paul; Diana Gibb; Rachel Vreeman; Elaine J Abrams; Rohan Hazra; Russell Van Dyke; Linda-Gail Bekker; Lynne Mofenson; Marissa Vicari; Shaffiq Essajee; Martina Penazzato; Gabriel Anabwani; Edith Q Mohapi; Peter N Kazembe; Makhosazana Hlatshwayo; Mwita Lumumba; Tessa Goetghebuer; Claire Thorne; Luisa Galli; Annemarie van Rossum; Carlo Giaquinto; Magdalena Marczynska; Laura Marques; Filipa Prata; Luminita Ene; Liubov Okhonskaia; Pablo Rojo; Claudia Fortuny; Lars Naver; Christoph Rudin; Sophie Le Coeur; Alla Volokha; Vanessa Rouzier; Regina Succi; Annette Sohn; Azar Kariminia; Andrew Edmonds; Patricia Lelo; Samuel Ayaya; Patricia Ongwen; Laura F Jefferys; Sam Phiri; Mwangelwa Mubiana-Mbewe; Shobna Sawry; Lorna Renner; Mariam Sylla; Mark J Abzug; Myron Levin; James Oleske; Miriam Chernoff; Shirley Traite; Murli Purswani; Ellen G Chadwick; Ali Judd; Valériane Leroy Journal: PLoS Med Date: 2018-03-01 Impact factor: 11.069
Authors: Ellen Brazier; Fernanda Maruri; Stephany N Duda; Olga Tymejczyk; C William Wester; Geoffrey Somi; Jeremy Ross; Aimee Freeman; Morna Cornell; Armel Poda; Beverly S Musick; Fujie Zhang; Keri N Althoff; Catrina Mugglin; April D Kimmel; Marcel Yotebieng; Denis Nash Journal: J Int AIDS Soc Date: 2019-07 Impact factor: 5.396
Authors: Elizabeth Zaniewski; Ellen Brazier; Cam Ha Dao Ostinelli; Robin Wood; Meg Osler; Karl-Günter Technau; Joep J van Oosterhout; Nicola Maxwell; Janneke van Dijk; Hans Prozesky; Matthew P Fox; Jacob Bor; Denis Nash; Matthias Egger Journal: J Clin Epidemiol Date: 2021-09-03 Impact factor: 6.437