Yapa, H Manisha; Kim, Hae-Young; Petoumenos, Kathy; Post, Frank A; Jiamsakul, Awachana; De Neve, Jan-Walter; Tanser, Frank; Iwuji, Collins; Baisley, Kathy; Shahmanesh, Maryam; +4 more... Pillay, Deenan; Siedner, Mark J; Bärnighausen, Till; Bor, Jacob; (2021) CD4+ T-Cell Count at Antiretroviral Therapy Initiation in the "Treat-All" Era in Rural South Africa: An Interrupted Time Series Analysis. Clinical infectious diseases, 74 (8). pp. 1350-1359. ISSN 1058-4838 DOI: https://doi.org/10.1093/cid/ciab650
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Abstract
BACKGROUND: South Africa implemented universal test and treat (UTT) in September 2016 in an effort to encourage earlier initiation of antiretroviral therapy (ART). METHODS: We therefore conducted an interrupted time series (ITS) analysis to assess the impact of UTT on mean CD4 count at ART initiation among adults aged ≥16 years attending 17 public sector primary care clinics in rural South Africa, between July 2014 and March 2019. RESULTS: Among 20 599 individuals (69% women), CD4 counts were available for 74%. Mean CD4 at ART initiation increased from 317.1 cells/μL (95% confidence interval [CI], 308.6 to 325.6) 1 to 8 months prior to UTT to 421.0 cells/μL (95% CI, 413.0 to 429.0) 1 to 12 months after UTT, including an immediate increase of 124.2 cells/μL (95% CI, 102.2 to 146.1). However, mean CD4 count subsequently fell to 389.5 cells/μL (95% CI, 381.8 to 397.1) 13 to 30 months after UTT but remained above pre-UTT levels. Men initiated ART at lower CD4 counts than women (-118.2 cells/μL, 95% CI, -125.5 to -111.0) throughout the study. CONCLUSIONS: Although UTT led to an immediate increase in CD4 count at ART initiation in this rural community, the long-term effects were modest. More efforts are needed to increase initiation of ART early in those living with human immunodeficiency virus, particularly men.
Item Type | Article |
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Keywords | HIV/AIDS, universal test and treat (UTT), CD4, antiretroviral therapy initiation |
Faculty and Department | Faculty of Epidemiology and Population Health > Dept of Infectious Disease Epidemiology & International Health (2023-) |
PubMed ID | 34309633 |
Elements ID | 165183 |