Virologic outcomes of people living with human immunodeficiency virus who started antiretroviral treatment on the same-day of diagnosis in Ethiopia: A multicenter observational study

Abstract

Introduction There have been tremendous achievements in scaling-up antiretroviral therapy (ART) for treatment of human immunodeficiency virus (HIV), following universal “test and treat” policy implementation in low- and middle-income countries. However, its effects on virologic outcomes is not yet well investigated. We compared low viral load status in people living with HIV between those who were initiated on ART on the same-day and after 7 days of being diagnosed with HIV infection. Methods We conducted a retrospective cohort study of persons age ≥15 years-old who were newly diagnosed and started on ART between October 2016 and July 2018 at 11 public health facilities in northwest Ethiopia. Exposure was initiation of ART on the same-day of HIV diagnosis. The outcome was low viral load at 12-months following ART initiation. We used double-robust estimator using inverse-probability-weighted regression adjustment to compare the groups. Results A total of 398 people who started ART on the same-day of HIV diagnosis and 479 people who started 7 days after the initial diagnosis were included in this study. By 12-months following ART initiation, 73.4% (292) in the same-day group vs 83.7% (401) in the >7 days group achieved low viral load (absolute difference = 10.3% (95% CI: 4.9%, 15.8%)). After adjusting for baseline and follow-up covariates, there was statistically significant difference in low viral load status (adjusted difference = 8.3% (95% CI: 3.5%, 13.0%)) between the same-day group and the >7 days group. Conclusions Achievement of low viral load by 12-months post-initiation of ART was not optimal among participants who started ART on the same-day of HIV diagnosis. Efforts should be made to reinforce treatment adherence while initiating same-day ART.

Adherence to Antiretroviral Treatment Among People Who Started Treatment on the Same-Day of HIV Diagnosis in Ethiopia: A Multicenter Observational Study

“…Our ART adherence results correlate with the lower viral suppression we found among same-day group in our previous publication that focused on virologic outcomes. 35 Viral load measurement has been used as…”

“…Our ART adherence results correlate with the lower viral suppression we found among same-day group in our previous publication that focused on virologic outcomes. 35 Viral load measurement has been used as another way of assessing ART adherence 36 — sometimes considered as the gold standard for monitoring ART adherence. 37…”

Prevalence of delayed antiretroviral therapy initiation among people living with HIV: A systematic review and meta-analysis

“…The HPTN 052 trial in nine African countries clearly showed that early initiation of ART with CD4 counts between 350 and 550 cells /mm 3 facilitated the faster achievement of viral load suppression and reduced HIV transmission by approximately 96% compared to late ART initiation with CD4 count < 250 cells /mm 3 [9]. Observational studies conducted in South Africa [10], Eswatini [11] and Ethiopia [12], which compared early treatment with standard care, reported similar results. Moreover, if ART is initiated immediately, the cost of hospitalization may be minimized in resource-poor and HIV-prone prevalence countries [13,14].…”