TY - JOUR
T1 - Brief Report
T2 - The Impact of Disease Stage on Early Gaps in ART in the "treatment for All" Era - A Multisite Cohort Study
AU - Katz, Ingrid T.
AU - Musinguzi, Nicholas
AU - Bell, Kathleen
AU - Cross, Anna
AU - Bwana, Mwebesa B.
AU - Amanyire, Gideon
AU - Asiimwe, Stephen
AU - Orrell, Catherine
AU - Bangsberg, David R.
AU - Haberer, Jessica E.
N1 - Funding Information:
Research Grant (OPP111363) from the Bill and Melinda Gates Foundation.
Publisher Copyright:
© 2020 The Author(s).
PY - 2021/4/15
Y1 - 2021/4/15
N2 - 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.
AB - 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.
KW - HIV
KW - South Africa
KW - Uganda
KW - early gaps
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U2 - 10.1097/QAI.0000000000002605
DO - 10.1097/QAI.0000000000002605
M3 - Article
C2 - 33351529
AN - SCOPUS:85102657745
VL - 86
SP - 562
EP - 567
JO - Journal of Acquired Immune Deficiency Syndromes and Human Retrovirology
JF - Journal of Acquired Immune Deficiency Syndromes and Human Retrovirology
SN - 1525-4135
IS - 5
ER -