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Publication Details
AFRICAN RESEARCH NEXUS
SHINING A SPOTLIGHT ON AFRICAN RESEARCH
medicine
Decreasing time to antiretroviral therapy initiation after HIV diagnosis in a clinic-based observational cohort study in four African countries
Journal of the International AIDS Society, Volume 23, No. 2, Article e25446, Year 2020
Notification
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Description
Introduction: World Health Organization (WHO) guidelines have shifted over time to recommend earlier initiation of antiretroviral therapy (ART) and now encourage ART initiation on the day of HIV diagnosis, if possible. However, barriers to ART access may delay initiation in resource-limited settings. We characterized temporal trends and other factors influencing the interval between HIV diagnosis and ART initiation among participants enrolled in a clinic-based cohort across four African countries. Methods: The African Cohort Study enrols adults engaged in care at 12 sites in Uganda, Kenya, Tanzania and Nigeria. Participants provide a medical history, complete a physical examination and undergo laboratory assessments every six months. Participants with recorded dates of HIV diagnosis were categorized by WHO guideline era (<2006, 2006 to 2009, 2010 to 2012, 2013 to 2015, ≥2016) at the time of diagnosis. Cox proportional hazard modelling was used to estimate hazard ratios (HRs) and 95% confidence intervals (95% CI) for time to ART initiation. Results and discussion: From January 2013 to September 2019, a total of 2888 adults living with HIV enrolled with known diagnosis dates. Median time to ART initiation decreased from 22.0 months (interquartile range (IQR) 4.0 to 77.3) among participants diagnosed prior to 2006 to 0.5 months (IQR 0.2 to 1.8) among those diagnosed in 2016 and later. Comparing those same periods, CD4 nadir increased from a median of 166 cells/mm3 (IQR: 81 to 286) to 298 cells/mm3 (IQR: 151 to 501). In the final adjusted model, participants diagnosed in each subsequent WHO guideline era had increased rates of ART initiation compared to those diagnosed before 2006. CD4 nadir ≥500 cells/mm3 was independently associated with a lower rate of ART initiation as compared to CD4 nadir <200 cells/mm3 (HR: 0.32; 95% CI: 0.28 to 0.37). Age >50 years at diagnosis was independently associated with shorter time to ART initiation as compared to 18 to 29 years (HR: 1.38; 95% CI: 1.19 to 1.61). Conclusions: Consistent with changing guidelines, the interval between diagnosis and ART initiation has decreased over time. Still, many adults living with HIV initiated treatment with low CD4, highlighting the need to diagnose HIV earlier while improving access to immediate ART after diagnosis. © 2020 Henry M Foundation for the Advancement of Military Medicine. Journal of the International AIDS Society published by John Wiley & Sons Ltd on behalf of the International AIDS Society.
Authors & Co-Authors
Esber, Allahna L.
United States, Silver Spring
Walter Reed Army Institute of Research
United States, Rockville
Hjf
Coakley, Peter
United States, Silver Spring
Walter Reed Army Institute of Research
United States, Rockville
Hjf
Ake, Julie A.
United States, Silver Spring
Walter Reed Army Institute of Research
Bahemana, Emmanuel
United States, Silver Spring
Walter Reed Army Institute of Research
Tanzania, Mbeya
Henry Jackson Foundation Mri
Adamu, Yakubu
United States, Silver Spring
Walter Reed Army Institute of Research
Kenya, Nairobi
Us Army Medical Research Directorate-africa
Nigeria, Abuja
Henry Jackson Foundation Mri
Kiweewa, Francis
Uganda, Kampala
Makerere University
Maswai, Jonah K.
United States, Silver Spring
Walter Reed Army Institute of Research
Kenya, Nairobi
Kenya Medical Research Institute
Kenya, Kisumu
Henry Jackson Foundation Mri
Owuoth, John Kevin
United States, Silver Spring
Walter Reed Army Institute of Research
Kenya, Nairobi
Kenya Medical Research Institute
Kenya, Kisumu
Henry Jackson Foundation Mri
Robb, Merlin Lee
United States, Silver Spring
Walter Reed Army Institute of Research
United States, Rockville
Hjf
Polyak, Christina S.
United States, Silver Spring
Walter Reed Army Institute of Research
United States, Rockville
Hjf
Crowell, Trevor A.
United States, Silver Spring
Walter Reed Army Institute of Research
United States, Rockville
Hjf
Parikh, Ajay P.
Unknown Affiliation
Hern, Jaclyn
Unknown Affiliation
Falodun, Olanrewaju
Unknown Affiliation
Song, Katherine X.
Unknown Affiliation
Milazzo, Mark J.
Unknown Affiliation
Dear, Nicole F.
Unknown Affiliation
Francisco, Leilani V.
Unknown Affiliation
Mankiewicz, Shauna
Unknown Affiliation
Schech, Steven
Unknown Affiliation
Golway, Alexandra
Unknown Affiliation
Mebrahtu, Tsedal
Unknown Affiliation
Lee, Elizabeth H.
Unknown Affiliation
Bohince, Kimberly
Unknown Affiliation
Hamm, Tiffany E.
Unknown Affiliation
Lombardi, Kara
Unknown Affiliation
Imbach, Michelle
Unknown Affiliation
Eller, Leigh Anne
Unknown Affiliation
Peel, Sheila A.
Unknown Affiliation
Malia, Jennifer A.
Unknown Affiliation
Kroidl, Arne L.
Unknown Affiliation
Kroidl, Inge
Unknown Affiliation
Geldmacher, Christof
Unknown Affiliation
Kafeero, Cate
Unknown Affiliation
Nambuya, Alice
Unknown Affiliation
Tegamanyi, Josephine
Unknown Affiliation
Birungi, Hellen
Unknown Affiliation
Mugagga, Olive
Unknown Affiliation
Nassali, G.
Unknown Affiliation
Wangiri, Paul
Unknown Affiliation
Nantabo, M.
Unknown Affiliation
Nambulondo, P.
Unknown Affiliation
Atwijuka, Brenda
Unknown Affiliation
Asiimwe, A.
Unknown Affiliation
Nabanoba, Christine T.
Unknown Affiliation
Semwogerere, Michael
Unknown Affiliation
Mwesigwa, Ronald
Unknown Affiliation
Jjuuko, S.
Unknown Affiliation
Namagembe, Rosemary
Unknown Affiliation
Bagyendagye, E.
Unknown Affiliation
Tindikahwa, Allan
Unknown Affiliation
Rwomushana, I.
Unknown Affiliation
Ssentongo, F.
Unknown Affiliation
Kibuuka, Hannah N.
Unknown Affiliation
Millard, Monica
Unknown Affiliation
Kapkiai, Joan
Unknown Affiliation
Wangare, Salome
Unknown Affiliation
Mangesoi, R.
Unknown Affiliation
Chepkwony, P.
Unknown Affiliation
Bor, L.
Unknown Affiliation
Maera, E.
Unknown Affiliation
Kasembeli, Alex N.
Unknown Affiliation
Rotich, Joshua
Unknown Affiliation
Kipkoech, C.
Unknown Affiliation
Chepkemoi, Winnie
Unknown Affiliation
Rono, Aiban
Unknown Affiliation
Kesi, Zeddy Bett
Unknown Affiliation
Ngeno, Janet
Unknown Affiliation
Langat, Edwin
Unknown Affiliation
Labosso, Kennedy
Unknown Affiliation
Langat, Ken
Unknown Affiliation
Kirui, Robert
Unknown Affiliation
Rotich, Linner
Unknown Affiliation
Mabwai, M.
Unknown Affiliation
Chelangat, Ella
Unknown Affiliation
Agutu, J.
Unknown Affiliation
Tonui, C.
Unknown Affiliation
Changwony, Enock
Unknown Affiliation
Bii, Margaret
Unknown Affiliation
Chumba, Ezekiel
Unknown Affiliation
Korir, Jackson C.
Unknown Affiliation
Sugut, Janet
Unknown Affiliation
Gitonga, Danson
Unknown Affiliation
Ngetich, Ronald Kiprotich
Unknown Affiliation
Kiprotich, Samuel
Unknown Affiliation
Rehema, Winne
Unknown Affiliation
Ogari, Celine
Unknown Affiliation
Ouma, Irene A.
Unknown Affiliation
Adimo, Oscar
Unknown Affiliation
Ogai, S.
Unknown Affiliation
Okwaro, Charles
Unknown Affiliation
Maranga, E.
Unknown Affiliation
Ochola, Jew
Unknown Affiliation
Obambo, Kennedy
Unknown Affiliation
Sing'Oei, Valentine Chepkorir
Unknown Affiliation
Otieno, Lucas
Unknown Affiliation
Nyapiedho, O.
Unknown Affiliation
Sande, Nellia
Unknown Affiliation
Odemba, E.
Unknown Affiliation
Wanjiru, F.
Unknown Affiliation
Khamadi, Samoel Ashimosi
Unknown Affiliation
Chiweka, Evarist
Unknown Affiliation
Lwilla, Anange
Unknown Affiliation
Mkondoo, Dorothy
Unknown Affiliation
Somi, Nancy
Unknown Affiliation
Mwaisanga, Gwamaka
Unknown Affiliation
Mwasulama, O. J.
Unknown Affiliation
Kishimbo, Peter
Unknown Affiliation
Mwamwaja, Jaquiline
Unknown Affiliation
McHaro, Ruby Doryn
Unknown Affiliation
Mtafya, Bariki A.
Unknown Affiliation
Kisinda, Abisai
Unknown Affiliation
Olomi, Willyhelmina
Unknown Affiliation
Adamu, Yahuza Mansur
Unknown Affiliation
Akintunde, Akindiran
Unknown Affiliation
Tiamiyu, Abdulwasiu Bolaji
Unknown Affiliation
Mohammed, Samirah Sani
Unknown Affiliation
Parker, Zahra F.
Unknown Affiliation
Azuakola, Nnamdi
Unknown Affiliation
Powell, Terrinieka Williams
Unknown Affiliation
Odeyemi, Sunday O.
Unknown Affiliation
Dogonyaro, Banenat B.
Unknown Affiliation
Statistics
Citations: 17
Authors: 122
Affiliations: 8
Identifiers
Doi:
10.1002/jia2.25446
ISSN:
17582652
Research Areas
Environmental
Health System And Policy
Infectious Diseases
Study Design
Cohort Study
Study Approach
Quantitative
Study Locations
Kenya
Nigeria
Tanzania
Uganda