102
|
Relationship Between Time to Initiation of Antiretroviral Therapy and Treatment Outcomes: A Cohort Analysis of ART Eligible Adolescents in Zimbabwe. J Acquir Immune Defic Syndr 2017; 74:390-398. [PMID: 28002183 PMCID: PMC5321111 DOI: 10.1097/qai.0000000000001274] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
Supplemental Digital Content is Available in the Text. Background: Age-specific retention challenges make antiretroviral therapy (ART) initiation in adolescents difficult, often requiring a lengthy preparation process. This needs to be balanced against the benefits of starting treatment quickly. The optimal time to initiation duration in adolescents is currently unknown. Objective: To assess the effect of time to ART initiation on mortality and loss to follow-up (LTFU) among treatment eligible adolescents. Methods: We conducted a retrospective cohort analysis among 1499 ART eligible adolescents aged ≥10 to <19 years registered in a public sector HIV program in Bulawayo, Zimbabwe, between 2004 and 2011. Hazard ratios (HR) for mortality and LTFU were calculated for different time to ART durations using multivariate Cox regression models. Results: Median follow-up duration was 1.6 years. Mortality HRs of patients who initiated at 0 to ≤7 days, >14 days to ≤1 month, >1 to ≤2 months, >2 months, and before initiation were 1.59, 1.19, 1.56, 1.08, and 0.94, respectively, compared with the reference group of >7 to ≤14 days. LTFU HRs were 1.02, 1.07, 0.85, 0.97, and 3.96, respectively. Among patients not on ART, 88% of deaths and 85% of LTFU occurred during the first 3 months after becoming ART eligible, but only 37% and 29% among adolescents on ART, respectively. Conclusions: Neither mortality or LTFU was associated with varying time to ART. The initiation process can be tailored to the adolescents' needs and individual life situations without risking to increase poor treatment outcomes. Early mortality was high despite rapid ART initiation, calling for earlier rather than faster initiation through HIV testing scale-up.
Collapse
|
103
|
Rosen S, Fox MP, Larson BA, Brennan AT, Maskew M, Tsikhutsu I, Bii M, Ehrenkranz PD, Venter WDF. Simplified clinical algorithm for identifying patients eligible for immediate initiation of antiretroviral therapy for HIV (SLATE): protocol for a randomised evaluation. BMJ Open 2017; 7:e016340. [PMID: 28554939 PMCID: PMC5726128 DOI: 10.1136/bmjopen-2017-016340] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
INTRODUCTION African countries are rapidly adopting guidelines to offer antiretroviral therapy (ART) to all HIV-infected individuals, regardless of CD4 count. For this policy of 'treat all' to succeed, millions of new patients must be initiated on ART as efficiently as possible. Studies have documented high losses of treatment-eligible patients from care before they receive their first dose of antiretrovirals (ARVs), due in part to a cumbersome, resource-intensive process for treatment initiation, requiring multiple clinic visits over a several-week period. METHODS AND ANALYSIS The Simplified Algorithm for Treatment Eligibility (SLATE) study is an individually randomised evaluation of a simplified clinical algorithm for clinicians to reliably determine a patient's eligibility for immediate ART initiation without waiting for laboratory results or additional clinic visits. SLATE will enrol and randomise (1:1) 960 adult, HIV-positive patients who present for HIV testing or care and are not yet on ART in South Africa and Kenya. Patients randomised to the standard arm will receive routine, standard of care ART initiation from clinic staff. Patients randomised to the intervention arm will be administered a symptom report, medical history, brief physical exam and readiness assessment. Patients who have positive (satisfactory) results for all four components of SLATE will be dispensed ARVs immediately, at the same clinic visit. Patients who have any negative results will be referred for further clinical investigation, counselling, tests or other services prior to being dispensed ARVs. After the initial visit, follow-up will be by passive medical record review. The primary outcomes will be ART initiation ≤28 days and retention in care 8 months after study enrolment. ETHICS AND DISSEMINATION Ethics approval has been provided by the Boston University Institutional Review Board, the University of the Witwatersrand Human Research Ethics Committee (Medical) and the KEMRI Scientific and Ethics Review Unit. Results will be published in peer-reviewed journals and made widely available through presentations and briefing documents. TRIAL REGISTRATION NCT02891135.
Collapse
Affiliation(s)
- Sydney Rosen
- Department of Global Health, Boston University School of Public Health, Boston, Massachusetts, USA
- Health Economics and Epidemiology Research Office, Department of Internal Medicine, School of Clinical Medicine, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Matthew P Fox
- Department of Global Health, Boston University School of Public Health, Boston, Massachusetts, USA
- Health Economics and Epidemiology Research Office, Department of Internal Medicine, School of Clinical Medicine, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
- Department of Epidemiology, Boston University School of Public Health, Boston, Massachusetts, USA
| | - Bruce A Larson
- Department of Global Health, Boston University School of Public Health, Boston, Massachusetts, USA
| | - Alana T Brennan
- Department of Global Health, Boston University School of Public Health, Boston, Massachusetts, USA
- Health Economics and Epidemiology Research Office, Department of Internal Medicine, School of Clinical Medicine, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Mhairi Maskew
- Health Economics and Epidemiology Research Office, Department of Internal Medicine, School of Clinical Medicine, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Isaac Tsikhutsu
- Kenya Medical Research Institute/Walter Reed Project HIV Program, Kericho, Kenya
| | - Margaret Bii
- Kenya Medical Research Institute/Walter Reed Project HIV Program, Kericho, Kenya
| | | | - WD Francois Venter
- Wits Reproductive Health and HIV Institute, Department of Internal Medicine, School of Clinical Medicine, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| |
Collapse
|
104
|
Ohata PJ, Nanthapisal K, Ruengpanyathip C, Sattayamong P, Avihingsanon A, Gatechompol S, Bunupuradah T, Hiransuthikul A, Kerr SJ, Do T, Puthanakit T, Kroon E, Colby D, Ramautarsing R, Kraus S, Harrison B, Bakkali T, Putcharoen O, Ruxrungtham K, Phanuphak P. Decades research and implementation science of HIV prevention, treatment and cure: highlights from Symposium 2017. Future Virol 2017. [DOI: 10.2217/fvl-2017-0016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
The 19th Bangkok International Symposium on HIV Medicine, Bangkok, Thailand, 18–20 January 2017 This training is one of the most established and largest, with up-to-date information provided by well-renowned international speakers and hence considered one of the best in the Asia Pacific region. The Symposium is offered every third week of January for three full days. Celebrating HIV Netherlands Australia Thailand research collaboration's 20th anniversary, for the first time, the sessions were covered real-time through webcasts, streamed live via the internet. Speakers included community advocates voicing and addressing certain issues, and the entire third day was dedicated to symposiums. HIV Netherlands Australia Thailand research collaboration continues to strive to provide well-rounded trainings of quality to the region's professional healthcare workers, hoping to significantly impact the delivery of health services. Noteworthy sessions have been briefly summarized in this report.
Collapse
Affiliation(s)
- Pirapon June Ohata
- HIV-NAT, Thai Red Cross AIDS Research Centre (TRCARC), 104 Ratchadamri Rd, Pathumwan, Bangkok 10330, Thailand
| | - Kesdao Nanthapisal
- HIV-NAT, Thai Red Cross AIDS Research Centre (TRCARC), 104 Ratchadamri Rd, Pathumwan, Bangkok 10330, Thailand
| | - Chavalun Ruengpanyathip
- HIV-NAT, Thai Red Cross AIDS Research Centre (TRCARC), 104 Ratchadamri Rd, Pathumwan, Bangkok 10330, Thailand
| | - Pornwinit Sattayamong
- HIV-NAT, Thai Red Cross AIDS Research Centre (TRCARC), 104 Ratchadamri Rd, Pathumwan, Bangkok 10330, Thailand
| | - Anchalee Avihingsanon
- HIV-NAT, Thai Red Cross AIDS Research Centre (TRCARC), 104 Ratchadamri Rd, Pathumwan, Bangkok 10330, Thailand
- Division of Allergy & Immunology, Faculty of Medicine, Chulalongkorn University, Rama IV Road, Pathumwan, Bangkok 10330, Thailand
| | - Sivaporn Gatechompol
- HIV-NAT, Thai Red Cross AIDS Research Centre (TRCARC), 104 Ratchadamri Rd, Pathumwan, Bangkok 10330, Thailand
| | - Torsak Bunupuradah
- HIV-NAT, Thai Red Cross AIDS Research Centre (TRCARC), 104 Ratchadamri Rd, Pathumwan, Bangkok 10330, Thailand
| | - Akarin Hiransuthikul
- HIV-NAT, Thai Red Cross AIDS Research Centre (TRCARC), 104 Ratchadamri Rd, Pathumwan, Bangkok 10330, Thailand
| | - Stephen J Kerr
- HIV-NAT, Thai Red Cross AIDS Research Centre (TRCARC), 104 Ratchadamri Rd, Pathumwan, Bangkok 10330, Thailand
| | - Tanya Do
- HIV-NAT, Thai Red Cross AIDS Research Centre (TRCARC), 104 Ratchadamri Rd, Pathumwan, Bangkok 10330, Thailand
| | - Thanyawee Puthanakit
- HIV-NAT, Thai Red Cross AIDS Research Centre (TRCARC), 104 Ratchadamri Rd, Pathumwan, Bangkok 10330, Thailand
- Department of Pediatrics, Faculty of Medicine, Chulalongkorn University, Rama IV Road, Pathumwan, Bangkok 10330, Thailand
| | - Eugene Kroon
- SEARCH, Thai Red Cross AIDS Research Centre (TRCARC), 104 Ratchadamri Rd, Pathumwan, Bangkok 10330, Thailand
| | - Donn Colby
- SEARCH, Thai Red Cross AIDS Research Centre (TRCARC), 104 Ratchadamri Rd, Pathumwan, Bangkok 10330, Thailand
| | - Reshmie Ramautarsing
- Prevention Unit, Thai Red Cross AIDS Research Centre (TRCARC), 104 Ratchadamri Rd, Pathumwan, Bangkok 10330, Thailand
| | - Steve Kraus
- Regional Support Team, Asia & the Pacific, UNAIDS Asia Pacific RST, 12th Floor, UN Building, Rajdamnern-nok Avenue, Phra Nakorn, Bangkok 10200, Thailand
| | - Brianna Harrison
- Regional Support Team, Asia & the Pacific, UNAIDS Asia Pacific RST, 12th Floor, UN Building, Rajdamnern-nok Avenue, Phra Nakorn, Bangkok 10200, Thailand
| | - Taoufik Bakkali
- Regional Support Team, Asia & the Pacific, UNAIDS Asia Pacific RST, 12th Floor, UN Building, Rajdamnern-nok Avenue, Phra Nakorn, Bangkok 10200, Thailand
| | - Opass Putcharoen
- Division of Infectious Diseases, Department of Medicine, Faculty of Medicine, Chulalongkorn University, Rama IV Road, Pathumwan, Bangkok 10330, Thailand
| | - Kiat Ruxrungtham
- HIV-NAT, Thai Red Cross AIDS Research Centre (TRCARC), 104 Ratchadamri Rd, Pathumwan, Bangkok 10330, Thailand
- Division of Allergy & Immunology, Faculty of Medicine, Chulalongkorn University, Rama IV Road, Pathumwan, Bangkok 10330, Thailand
| | - Praphan Phanuphak
- HIV-NAT, Thai Red Cross AIDS Research Centre (TRCARC), 104 Ratchadamri Rd, Pathumwan, Bangkok 10330, Thailand
- SEARCH, Thai Red Cross AIDS Research Centre (TRCARC), 104 Ratchadamri Rd, Pathumwan, Bangkok 10330, Thailand
- Prevention Unit, Thai Red Cross AIDS Research Centre (TRCARC), 104 Ratchadamri Rd, Pathumwan, Bangkok 10330, Thailand
| | | |
Collapse
|
106
|
Rosen S, Fox MP, Larson BA, Sow PS, Ehrenkranz PD, Venter F, Manabe YC, Kaplan J. Accelerating the Uptake and Timing of Antiretroviral Therapy Initiation in Sub-Saharan Africa: An Operations Research Agenda. PLoS Med 2016; 13:e1002106. [PMID: 27505444 PMCID: PMC4978457 DOI: 10.1371/journal.pmed.1002106] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
Abstract
Sydney Rosen and colleagues describe an operations research agenda to accelerating uptake of HIV treatment initiation.
Collapse
Affiliation(s)
- Sydney Rosen
- Department of Global Health, Boston University School of Public Health, Boston, Massachusetts, United States of America
- Health Economics and Epidemiology Research Office, Department of Internal Medicine, School of Clinical Medicine, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
- * E-mail:
| | - Matthew P. Fox
- Department of Global Health, Boston University School of Public Health, Boston, Massachusetts, United States of America
- Health Economics and Epidemiology Research Office, Department of Internal Medicine, School of Clinical Medicine, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
- Department of Epidemiology, Boston University School of Public Health, Boston, Massachusetts, United States of America
| | - Bruce A. Larson
- Department of Global Health, Boston University School of Public Health, Boston, Massachusetts, United States of America
| | - Papa Salif Sow
- Bill & Melinda Gates Foundation, Seattle, Washington, United States of America
- Department of infectious Diseases, University of Dakar, Dakar, Senegal
| | - Peter D. Ehrenkranz
- Bill & Melinda Gates Foundation, Seattle, Washington, United States of America
| | - Francois Venter
- Wits Reproductive Health and HIV Institute, Department of Internal Medicine, School of Clinical Medicine, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Yukari C. Manabe
- Division of Infectious Diseases, Department of Medicine, Johns Hopkins School of Medicine, Baltimore, Maryland, United States of America
| | - Jonathan Kaplan
- Independent investigator, Atlanta, Georgia, United States of America
| | | |
Collapse
|