Brief Report: The Impact of Disease Stage on Early Gaps in ART in the "treatment for All" Era - A Multisite Cohort Study

Ingrid T. Katz, Nicholas Musinguzi, Kathleen Bell, Anna Cross, Mwebesa B. Bwana, Gideon Amanyire, Stephen Asiimwe, Catherine Orrell, David R. Bangsberg, Jessica E. Haberer

Research output: Contribution to journalArticlepeer-review


Background: Adoption of "Treat All"policies has increased antiretroviral therapy (ART) initiation in sub-Saharan Africa; however, unexplained early losses continue to occur. More information is needed to understand why treatment discontinuation continues at this vulnerable stage in care.Methods: The Monitoring Early Treatment Adherence Study involved a prospective observational cohort of individuals initiating ART at early-stage versus late-stage disease in South Africa and Uganda. Surveys and HIV-1 RNA levels were performed at baseline, 6, and 12 months, with adherence monitored electronically. This analysis included nonpregnant participants in the first 6 months of follow-up; demographic and clinical factors were compared across groups with χ2, univariable, and multivariable models.Results: Of 669 eligible participants, 91 (14%) showed early gaps of ≥30 days in ART use (22% in South Africa and 6% in Uganda) with the median time to gap of 77 days (interquartile range: 43-101) and 87 days (74, 105), respectively. Although 71 (78%) ultimately resumed care, having an early gap was still significantly associated with detectable viremia at 6 months (P ≤ 0.01). Multivariable modeling, restricted to South Africa, found secondary education and higher physical health score protected against early gaps [adjusted odds ratio (aOR) 0.4, 95% confidence interval (CI): 0.2 to 0.8 and (aOR 0.93, 95% CI: 0.9 to 1.0), respectively]. Participants reporting clinics as "too far"had double the odds of early gaps (aOR 2.2: 95% CI: 1.2 to 4.1).Discussion: Early gaps in ART persist, resulting in higher odds of detectable viremia, particularly in South Africa. Interventions targeting health management and access to care are critical to reducing early gaps.

Original languageEnglish (US)
Pages (from-to)562-567
Number of pages6
JournalJournal of Acquired Immune Deficiency Syndromes
Issue number5
StatePublished - Apr 15 2021


  • HIV
  • South Africa
  • Uganda
  • early gaps

ASJC Scopus subject areas

  • Infectious Diseases
  • Pharmacology (medical)


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