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Effects of national adoption of Treat-All guidelines on pre-ART CD4 testing and viral load monitoring after ART initiation: A regression discontinuity analysis

dc.rights.licenseopenen_US
dc.contributor.authorBRAZIER, Ellen
dc.contributor.authorTYMEJCZYK, Olga
dc.contributor.authorZANIEWSKI, Elizabeth
dc.contributor.authorEGGER, Matthias
dc.contributor.authorWOOLS-KALOUSTIAN, Kara
dc.contributor.authorYIANNOUTSOS, Constantin T.
hal.structure.identifierBordeaux population health [BPH]
dc.contributor.authorJAQUET, Antoine
dc.contributor.authorALTHOFF, Keri N.
dc.contributor.authorLEE, Jennifer S.
dc.contributor.authorCARO-VEGA, Yanink
dc.contributor.authorLUZ, Paula M.
dc.contributor.authorTANUMA, Junko
dc.contributor.authorNIYONGABO, Theodore
dc.contributor.authorNASH, Denis
dc.date.accessioned2021-05-10T09:21:36Z
dc.date.available2021-05-10T09:21:36Z
dc.date.issued2021-03-09
dc.identifier.issn1058-4838en_US
dc.identifier.urihttps://oskar-bordeaux.fr/handle/20.500.12278/27223
dc.description.abstractEnBACKGROUND: The World Health Organization's Treat-All guidance recommends CD4 testing prior to antiretroviral treatment (ART) initiation, and routine viral load (VL) monitoring (over CD4 monitoring) for patients on ART. METHODS: We used regression discontinuity analyses to estimate changes in CD4 testing and VL monitoring among 547,837 ART-naïve patients enrolling in HIV care during 2006-2018 at 225 clinics in 26 countries where Treat-All policies were adopted. We examined CD4 testing within 12 months before and VL monitoring 6 months after ART initiation among adults (≥20 years), adolescents (10-19 years) and children (0-9 years) in low/lower-middle income countries (L/LMICs) and high/upper-middle income countries (H/UMICs). RESULTS: Treat-All adoption led to an immediate decrease in pre-ART CD4 testing among adults in L/LMICs, from 57.0% to 48.1% (-8.9 percentage points [pp]; 95% CI: -11.0, -6.8), and a small increase in in H/UMICs, from 90.1 to 91.7% (+1.6pp; 95% CI: 0.2, 3.0), with no changes among adolescents or children; decreases in pre-ART CD4 testing accelerated after Treat-All adoption in L/LMICs. In L/LMICs, VL monitoring after ART initiation was low among all patients just before Treat-All; while there was no immediate change at Treat-All adoption, VL monitoring trends significantly increased afterwards. In H/UMICs, VL monitoring increased among adults immediately after Treat-All adoption, from 58.2% to 61.1% (+2.9pp; 95% CI: 0.5, 5.4), with no significant changes among adolescents/children. CONCLUSIONS: While on-ART VL monitoring has improved in L/LMICs, Treat-All adoption has accelerated and disparately worsened suboptimal pre-ART CD4 monitoring, which may compromise care outcomes for individuals with advanced HIV.
dc.language.isoENen_US
dc.rightsAttribution-NonCommercial-NoDerivs 3.0 United States*
dc.rights.urihttp://creativecommons.org/licenses/by-nc-nd/3.0/us/*
dc.subjectHIV care
dc.subjectPre-ART CD4 testing
dc.subjectViral load monitoring
dc.subjectTreat-All
dc.title.enEffects of national adoption of Treat-All guidelines on pre-ART CD4 testing and viral load monitoring after ART initiation: A regression discontinuity analysis
dc.typeArticle de revueen_US
dc.identifier.doi10.1093/cid/ciab222en_US
dc.subject.halSciences du Vivant [q-bio]/Santé publique et épidémiologieen_US
dc.identifier.pubmed33693517en_US
bordeaux.journalClinical Infectious Diseasesen_US
bordeaux.hal.laboratoriesBordeaux Population Health Research Center (BPH) - U1219en_US
bordeaux.institutionUniversité de Bordeauxen_US
bordeaux.institutionINSERMen_US
bordeaux.teamIDLICen_US
bordeaux.peerReviewedouien_US
bordeaux.inpressnonen_US
hal.identifierhal-03222380
hal.version1
hal.date.transferred2021-05-10T09:21:41Z
hal.exporttrue
bordeaux.COinSctx_ver=Z39.88-2004&rft_val_fmt=info:ofi/fmt:kev:mtx:journal&rft.jtitle=Clinical%20Infectious%20Diseases&rft.date=2021-03-09&rft.eissn=1058-4838&rft.issn=1058-4838&rft.au=BRAZIER,%20Ellen&TYMEJCZYK,%20Olga&ZANIEWSKI,%20Elizabeth&EGGER,%20Matthias&WOOLS-KALOUSTIAN,%20Kara&rft.genre=article


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