Effects of implementing universal and rapid HIV treatment on initiation of antiretroviral therapy and retention in care in Zambia: a natural experiment using regression discontinuity

Mody, Aaloke; Sikazwe, Izukanji; Namwase, Angella Sandra; Mwanza, Mwanza Wa; Savory, Theodora; Mwila, Annie; Mulenga, Lloyd; Herce, Michael E; Mweebo, Keith; Somwe, Paul; Eshun‐Wilson, Ingrid; Sikombe, Kombatende; Beres, Laura K.; Pry, Jake; Holmes, Charles B.; Bolton-Moore, Carolyn; Geng, Elvin

doi:10.1016/s2352-3018(21)00186-7

Cited by 29 publications

(20 citation statements)

References 31 publications

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“…However, such studies must employ strong research designs to produce sound results. Experimental and quasi-experimental research methods (such as stepped wedge cluster randomised trials [66,67] and regression discontinuity designs [68,69] can be nested pragmatically within large implementation programs. Implementing partners may also contract external evaluation partners to rigorously assess the impact of interventions.…”

Section: Discussionmentioning

confidence: 99%

Strategies to improve antiretroviral therapy (ART) initiation and early engagement among men insub‐SaharanAfrica: A scoping review of interventions in the era of universal treatment

Dovel

Hariprasad

Hubbard

et al. 2023

Tropical Med Int Health

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Objectives: Men in sub-Saharan Africa (SSA) have lower rates of antiretroviral therapy (ART) initiation and higher rates of early default than women. Little is known about effective interventions to improve men's outcomes. We conducted a scoping review of interventions aimed to increase ART initiation and/or early retention among men in SSA since universal treatment policies were implemented. Methods: Three databases, HIV conference databases and grey literature were searched for studies published between January 2016 to May 2021 that reported on initiation and/or early retention among men. Eligibility criteria included: participants in SSA, data collected after universal treatment policies were implemented (2016)(2017)(2018)(2019)(2020)(2021), quantitative data on ART initiation and/or early retention for males, general male population (not exclusively focused on key populations), intervention study (report outcomes for at least one non-standard service delivery strategy), and written in English. Results: Of the 4351 sources retrieved, 15 (reporting on 16 interventions) met inclusion criteria. Of the 16 interventions, only two (2/16, 13%) exclusively focused on men. Five (5/16, 31%) were randomised control trials (RCT), one (1/16, 6%) was a retrospective cohort study, and 10 (10/16, 63%) did not have comparison groups. Thirteen (13/16, 81%) interventions measured ART initiation and six (6/16, 37%) measured early retention. Outcome definitions and time frames varied greatly, with seven (7/16, 44%) not specifying time frames at all. Five types of interventions were represented: optimising ART services at health facilities, community-based ART services, outreach support (such as reminders and facility escort), counselling and/or peer support, and conditional incentives. Across all intervention types, ART initiation rates ranged from 27% to 97% and early retention from 47% to 95%. Conclusions: Despite years of data of men's suboptimal ART outcomes, there is little high-quality evidence on interventions to increase men's ART initiation or early retention in SSA. Additional randomised or quasi-experimental studies are urgently needed.

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Section: Discussionmentioning

confidence: 99%

Strategies to improve antiretroviral therapy (ART) initiation and early engagement among men insub‐SaharanAfrica: A scoping review of interventions in the era of universal treatment

Dovel

Hariprasad

Hubbard

et al. 2023

Tropical Med Int Health

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“…In Zambia, uptake of SDI increased from 42% to 75% of newly initiating patients between the beginning of 2016 and the beginning of 2018, a phenomenon attributed largely to the adoption of universal treatment eligibility in 2017 11 . By the time our data were collected in 2018-2020, Zambia's SDI rate had increased to more than 91% (Table 3).…”

Section: Discussionmentioning

confidence: 99%

Uptake of same-day initiation of HIV treatment among adult men and women in Malawi, South Africa, and Zambia: the SPRINT retrospective cohort study

et al. 2023

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Background: Since 2017 global guidelines have recommended “same-day initiation” (SDI) of antiretroviral treatment (ART) for patients considered ready for treatment on the day of HIV diagnosis. Many countries have incorporated a SDI option into national guidelines, but SDI uptake is not well documented. We estimated average time to ART initiation at 12 public healthcare facilities in Malawi, five in South Africa, and 12 in Zambia. Methods: We sequentially enrolled patients eligible to start ART between January 2018 and June 2019 and reviewed their medical records from the point of HIV diagnosis or first HIV-related interaction with the clinic to the earlier date of treatment initiation or 6 months. We estimated the proportion of patients initiating ART on the same day or within 7, 14, 30, or 180 days of baseline. Results: We enrolled 826 patients in Malawi, 534 in South Africa, and 1,984 in Zambia. Overall, 88% of patients in Malawi, 57% in South Africa, and 91% in Zambia were offered and accepted SDI. In Malawi, most who did not receive SDI had not initiated ART ≤6 months. In South Africa, an additional 13% initiated ≤1 week, but 21% had no record of initiation ≤6 months. Among those who did initiate within 6 months in Zambia, most started ≤1 week. There were no major differences by sex. WHO Stage III/IV and tuberculosis symptoms were associated with delays in ART initiation. Conclusions: As of 2020, SDI of ART was widespread, if not nearly universal, in Malawi and Zambia but considerably less common in South Africa. Limitations of the study include pre-COVID-19 data that do not reflect pandemic adaptations and potentially missing data for Zambia. South Africa may be able to increase overall ART coverage by reducing numbers of patients who do not initiate ≤6 months. Registration: Clinicaltrials.gov (NCT04468399; NCT04170374; NCT04470011).

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“… 25 reducing, but not eliminating, disparities in treatment initiation. 26 Interventions to achieve the 95–95–95 target should account for the heterogeneity of inequalities PLHIV face at each step of the care cascade.…”

Section: Discussionmentioning

confidence: 99%

“… 7 , 6 , 8 HIV testing and treatment programs may be leaving behind ALHIV. 26 and MLHIV due to the unique socioeconomic inequalities these populations face. HIV testing and treatment programs should address age and gender-related inequalities facing ALHIV and MLHIV in achieving the 90–90–90 target.…”

Section: Discussionmentioning

confidence: 99%

Socioeconomic inequalities in the 90–90–90 target, among people living with HIV in 12 sub-Saharan African countries — Implications for achieving the 95–95–95 target — Analysis of population-based surveys

Chipanta¹,

Amo-Agyei²,

Giovenco³

et al. 2022

eClinicalMedicine

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Effects of implementing universal and rapid HIV treatment on initiation of antiretroviral therapy and retention in care in Zambia: a natural experiment using regression discontinuity

Cited by 29 publications

References 31 publications

Strategies to improve antiretroviral therapy (ART) initiation and early engagement among men insub‐SaharanAfrica: A scoping review of interventions in the era of universal treatment

Strategies to improve antiretroviral therapy (ART) initiation and early engagement among men insub‐SaharanAfrica: A scoping review of interventions in the era of universal treatment

Uptake of same-day initiation of HIV treatment among adult men and women in Malawi, South Africa, and Zambia: the SPRINT retrospective cohort study

Socioeconomic inequalities in the 90–90–90 target, among people living with HIV in 12 sub-Saharan African countries — Implications for achieving the 95–95–95 target — Analysis of population-based surveys

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