Fiona Walsh1, Shaukat Khan2, Till Bärnighausen3,4,5, Anita Hettema6, Charlotte Lejeune7, Sikhathele Mazibuko8, Charmaine Khudzie Mlambo6, Ria Reis9,10,11, Yvette Fleming12, Gavin Khumalo13, Mandisa Zwane14, Velephi Okello15, Donna Spiegelman16,17. 1. Mesurado Cooperative, Cambridge, MA, USA. 2. Clinton Health Access Initiative (CHAI), 333 Dorchester Avenue, Boston, MA, USA. 3. Heidelberg Institute of Global Health, University of Heidelberg, 130.3 INF, 69120, Heidelberg, Germany. 4. Department of Global Health and Population, Harvard T.H Chan School of Public Health, Boston, MA, USA. 5. Africa Health Research Institute, KwaZulu-Natal, South Africa. 6. Clinton Health Access Initiative (CHAI), Tsekwane St, Mbabane, Eswatini. 7. Clinton Health Access Initiative (CHAI), Dakar, Senegal. 8. Eswatini National ART Program (SNAP), Ministry of Health, Mbabane, Eswatini. 9. Leiden University Medical Center, Leiden University, Leiden, Netherlands. 10. Amsterdam Institute for Social Science, University of Amsterdam, 1012 WX, Amsterdam, Netherlands. 11. Children's Institute, University of Cape Town, Cape Town, South Africa. 12. aidsfonds, Condensatorweg 54, 1014 AX, Amsterdam, Netherlands. 13. Eswatini National Network of People Living with HIV (SWANNEPHA), P. O. Box 4161, Mbabane, Eswatini. 14. SAfAIDS, Lamvelase Building, Nkoseluhlaza Street, Manzini, Eswatini. 15. Directorate Office, Ministry of Health, Mbabane, Eswatini. 16. Department of Biostatistics, Center on Methods for Implementation and Prevention Science, Yale School of Public Health, 60 College Street, New Haven, CT, 06510, USA. donna.spiegelman@yale.edu. 17. Departments of Epidemiology, Biostatistics, Nutrition and Global Health, Harvard T.H Chan School of Public Health, Boston, MA, USA. donna.spiegelman@yale.edu.
Abstract
PURPOSE OF REVIEW: The MaxART Consortium-led by the Eswatini Ministry of Health-implemented multiple interventions between 2012 and 2017 to achieve UNAIDS 90-90-90 targets. We summarize key findings from community outreach strategies in support of the first 90 goal, and from the Early Access to ART for All (EAAA) trial on the implementation of a "Treat All" strategy to achieve the second and third 90 goals within a government-managed public health system. RECENT FINDINGS: The MaxART Consortium demonstrated that "Fast Track," a problem-solving approach, was effective at increasing testing coverage in the community. Compared with baseline data at 3 months prior to the start of the Fast Track, there was a 273% proportional increase in HIV tests conducted among adolescent males, adolescent females, and adult men, and 722% over baseline for adolescent males. The MaxART EAAA trial further showed that implementation of the Treat All policy was associated with significant two-fold shorter time from enrollment into care to ART initiation than under the standard CD4+ cell threshold-based treatment guidelines. Finally, through the MaxART trial, Eswatini was able to identify areas for further investment, including addressing the system-side barriers to routine viral load monitoring, and designing and implementing innovative community-based approaches to reach individuals who were not more routinely accessing HIV testing and counseling services. As low- and middle-income countries adopt the Treat All approach in their national HIV care and treatment guidelines, further implementation science research is needed to understand and address the system-level barriers to achieving the benefits of Treat All for HIV-infected individuals and those at risk.
PURPOSE OF REVIEW: The MaxART Consortium-led by the Eswatini Ministry of Health-implemented multiple interventions between 2012 and 2017 to achieve UNAIDS 90-90-90 targets. We summarize key findings from community outreach strategies in support of the first 90 goal, and from the Early Access to ART for All (EAAA) trial on the implementation of a "Treat All" strategy to achieve the second and third 90 goals within a government-managed public health system. RECENT FINDINGS: The MaxART Consortium demonstrated that "Fast Track," a problem-solving approach, was effective at increasing testing coverage in the community. Compared with baseline data at 3 months prior to the start of the Fast Track, there was a 273% proportional increase in HIV tests conducted among adolescent males, adolescent females, and adult men, and 722% over baseline for adolescent males. The MaxART EAAA trial further showed that implementation of the Treat All policy was associated with significant two-fold shorter time from enrollment into care to ART initiation than under the standard CD4+ cell threshold-based treatment guidelines. Finally, through the MaxART trial, Eswatini was able to identify areas for further investment, including addressing the system-side barriers to routine viral load monitoring, and designing and implementing innovative community-based approaches to reach individuals who were not more routinely accessing HIV testing and counseling services. As low- and middle-income countries adopt the Treat All approach in their national HIV care and treatment guidelines, further implementation science research is needed to understand and address the system-level barriers to achieving the benefits of Treat All for HIV-infected individuals and those at risk.
Entities:
Keywords:
Eswatini; HIV testing; Retention; Sub-Saharan Africa; Universal test and treat; Viral suppression
Authors: Marie A Brault; Sarah Christie; Sasha Aquino; Abigail Rendin; Amanda Manchia; Leslie A Curry; Erika L Linnander Journal: SAHARA J Date: 2021-12