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Bayisa L, Bayisa D, Turi E, Mulisa D, Tolossa T, Akuma AO, Bokora MC, Rundasa DT. Same-Day ART Initiation and Associated Factors Among People Living with HIV on Lifelong Therapy at Nekemte Specialized Hospital, Western Ethiopia. HIV AIDS (Auckl) 2023; 15:11-22. [PMID: 36718213 PMCID: PMC9884049 DOI: 10.2147/hiv.s395238] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2022] [Accepted: 01/13/2023] [Indexed: 01/26/2023] Open
Abstract
Background The test-and-treat approach recommends early ART initiation (same day). Early ART start has double the benefits as treatment and as prevention. However, there is limited information regarding same-day ART initiation in Ethiopia. Hence, this study aimed to assess the magnitude and factors of same-day ART initiation among people living with HIV (PLHIV) on ART at Nekemte specialized hospital, in Western Ethiopia. Methods A cross-sectional study was conducted among 483 PLHIV from January 10 to February 15, 2021. Data were collected using an investigator-administered questionnaire. Epi Data 3.1 and STATA 14.0 were used for data entry and analysis, respectively. Variables with P-value <0.25 from bivariable analysis were included in the multivariable analysis. AOR with 95% CI and P-value <0.05 were used to declare statistical significance. Results A total of 483 study subjects participated and gave a 100% response rate. Two thirds (65%) of them started ART on the same day with a 95% CI [60.2-68.8]. Urban dwellers (AOR = 3.93 (95% 1.96-7.87)), with no OIs (AOR = 4.02 (95% CI: 1.54-10.47)), not screened for TB (AOR = 6.02 (95% CI: 1.71-21.15)), tested via VCT (AOR = 2.32 (95% CI: 1.37-3.26)), who have not used CPT (AOR = 1.88 (95% CI: 1.10-3.23)), who have not used IPT (AOR = 2.36 (95% CI: 1.0-5.57)), who were tested in 2019/20 (AOR = 2.37 (95% CI: 1.08-5.518)), and with BMI ≥25 kg/m2 (AOR = 2.18 (95% CI: 1.05-4.52)) were significantly associated with same-day ART initiation. Conclusion Two thirds of study subjects initiated ART on the same day as HIV diagnosis. Voluntary testing and immediate referral to HIV care, advocating test-and-treat, and intensive counseling should be strengthened and reinforced for newly diagnosed HIV-positive people. Given that, high attention should be paid to individuals from urban residence, not screened for TB, who have not used CPT and IPT prophylaxis.
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Affiliation(s)
- Lami Bayisa
- Department of Nursing, School of Nursing and Midwifery, Wollega University, Nekemte, Ethiopia,Correspondence: Lami Bayisa, Department of Nursing, School of Nursing and Midwifery, Wollega University, P.O.Box: 395, Nekemte, Ethiopia, Tel +251 924318135, Email
| | - Diriba Bayisa
- Department of Midwifery, School of Nursing and Midwifery, Wollega University, Nekemte, Ethiopia
| | - Ebisa Turi
- Department of Public Health, Institute of Health Sciences, Wollega University, Nekemte, Ethiopia
| | - Diriba Mulisa
- Department of Nursing, School of Nursing and Midwifery, Wollega University, Nekemte, Ethiopia
| | - Tadesse Tolossa
- Department of Public Health, Institute of Health Sciences, Wollega University, Nekemte, Ethiopia
| | - Adugna Olani Akuma
- Department of Nursing, School of Nursing and Midwifery, Wollega University, Nekemte, Ethiopia
| | - Merga Chala Bokora
- Department of Midwifery, School of Nursing and Midwifery, Wollega University, Nekemte, Ethiopia
| | - Dawit Tesfaye Rundasa
- Department of Nursing, School of Nursing and Midwifery, Wollega University, Nekemte, Ethiopia
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Zhong M, Li M, Qi M, Su Y, Yu N, Lv R, Ye Z, Zhang X, Xu X, Cheng C, Chen C, Wei H. A retrospective clinical study of dolutegravir- versus efavirenz-based regimen in treatment-naïve patients with advanced HIV infection in Nanjing, China. Front Immunol 2023; 13:1033098. [PMID: 36700216 PMCID: PMC9868135 DOI: 10.3389/fimmu.2022.1033098] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2022] [Accepted: 12/14/2022] [Indexed: 01/11/2023] Open
Abstract
Currently, there are limited data related to the efficacy and safety of ART regimens, as well as factors influencing immune recovery in antiretroviral therapy (ART)-naïve patients with advanced HIV infection, especially in China. We designed a single-center, retrospective cohort study from March 1, 2019, to May 31, 2022, at The Second Hospital of Nanjing, China. ART-naïve adults with advanced HIV infection (CD4+ T-cell count < 200 cells/μL) who met the study criteria were included. The plasma viral load (VL), CD4+ T-cell count, CD4/CD8 ratio, treatment discontinuation, and immune reconstitution inflammatory syndrome (IRIS) events were collected to compare the efficacy and safety of the dolutegravir (DTG) and the efavirenz (EFV) regimens. Factors of immune recovery were analyzed using the Cox regression model. Study enrolled 285 ART-naïve adults with advanced HIV-1 infection, of which 95 (33.3%) started regimens including DTG and 190 (66.7%) were treated with EFV. After ART initiation, the proportion of patients with HIV-1 RNA < 50 copies/mL was higher (22.5% versus 6.5%, P < 0.001) in those on DTG-based regimens at month 1, but no significant difference at other follow-up points. Compared to the baseline, the median CD4+ T-cell count and CD4/CD8 ratio increased significantly during follow-up both in the EFV and the DTG groups. However, the CD4+ T-cell count increased greater in patients on DTG-based regimens at months 6, 12, 24, and 36 (P < 0.05). A total of 52 (18.2%) patients discontinued treatment, with no significant difference between ART regimens in treatment discontinuation rates. Only 7 patients reported IRIS, without significant difference between ART regimens (P=0.224). Overall, 34.0% (97/285) achieved a CD4+ T-cell count ≥ 350 cells/μL during follow-up. Age (P < 0.001), baseline CD4+ T-cell count (P < 0.001), baseline VL (P < 0.001) and ART regimens (P = 0.019) were associated with the CD4+ T-cell count ≥ 350 cells/μL after adjusting for potential confounders. Among ART-naïve adults with advanced HIV infection, it appeared that DTG-based regimens were better options for initial therapy compared to regimens including EFV; in addition, ART regimens, age, baseline VL and CD4+ T-cell count were associated with immune recovery.
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Affiliation(s)
- Mingli Zhong
- Department of Infectious Disease, The Second Hospital of Nanjing, School of Public Health, Nanjing Medical University, Nanjing, China
| | - Mengqing Li
- Department of Infectious Disease, The Second Hospital of Nanjing, School of Public Health, Nanjing Medical University, Nanjing, China
| | - Mingxue Qi
- Department of Infectious Disease, The Second Hospital of Nanjing, Nanjing University of Chinese Medicine, Nanjing, China
| | - Yifan Su
- Department of Infectious Disease, The Second Hospital of Nanjing, Nanjing University of Chinese Medicine, Nanjing, China
| | - Nawei Yu
- Department of Infectious Disease, The Second Hospital of Nanjing, Nanjing University of Chinese Medicine, Nanjing, China
| | - Ru Lv
- Department of Infectious Disease, The Second Hospital of Nanjing, Nanjing University of Chinese Medicine, Nanjing, China
| | - Zi Ye
- Department of Infectious Disease, The Second Hospital of Nanjing, Nanjing University of Chinese Medicine, Nanjing, China
| | - Xiang Zhang
- Department of Infectious Disease, The Second Hospital of Nanjing, Nanjing University of Chinese Medicine, Nanjing, China
| | - Xinglian Xu
- Department of Infectious Disease, The Second Hospital of Nanjing, Nanjing University of Chinese Medicine, Nanjing, China
| | - Cong Cheng
- Department of Infectious Disease, The Second Hospital of Nanjing, Nanjing University of Chinese Medicine, Nanjing, China
| | - Chen Chen
- Department of Infectious Disease, The Second Hospital of Nanjing, Nanjing University of Chinese Medicine, Nanjing, China,*Correspondence: Hongxia Wei, ; Chen Chen,
| | - Hongxia Wei
- Department of Infectious Disease, The Second Hospital of Nanjing, School of Public Health, Nanjing Medical University, Nanjing, China,*Correspondence: Hongxia Wei, ; Chen Chen,
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Bekele A, Hrapcak S, Mohammed JA, Yimam JA, Tilahun T, Antefe T, Kumssa H, Kassa D, Mengistu S, Mirkovic K, Dziuban EJ, Belay Z, Ross C, Teferi W. Rates of confirmatory HIV testing, linkage to HIV services, and rapid initiation of antiretroviral treatment among newly diagnosed children living with HIV in Ethiopia: perspectives from caregivers and healthcare workers. BMC Pediatr 2022; 22:736. [PMID: 36572846 PMCID: PMC9791729 DOI: 10.1186/s12887-022-03784-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/11/2022] [Accepted: 11/30/2022] [Indexed: 12/27/2022] Open
Abstract
BACKGROUND Successful linkage to HIV services and initiation of antiretroviral treatment (ART) for children living with HIV (CLHIV) is critical to improve pediatric ART coverage. We aimed to assess confirmatory testing, linkage, and rapid ART initiation among newly diagnosed CLHIV in Ethiopia from the perspectives of caregivers and healthcare workers (HCWs). METHODS We conducted standardized surveys with HCWs and caregivers of children 2-14 years who were diagnosed with HIV but not yet on ART who had been identified during a cross-sectional study in Ethiopia from May 2017-March 2018. Eight health facilities based on their HIV caseload and testing volume and 21 extension sites were included. Forty-one children, 34 care givers and 40 healthcare workers were included in this study. Three months after study enrollment, caregivers were surveyed about timing and experiences with HIV service enrollment, confirmatory testing, and ART initiation. Data collected from HCWs included perceptions of confirmatory testing in CLHIV before ART initiation. SPSS was used to conduct descriptive statistics. RESULTS The majority of the 41 CLHIV were enrolled to HIV services (n = 34, 83%) and initiated ART by three months (n = 32, 94%). Median time from diagnosis to ART initiation was 12 days (interquartile range 5-18). Five children died before the follow-up interview. Confirmatory HIV testing was conducted in 34 children and found no discordant results; the majority (n = 23, 68%) received it within one week of HIV diagnosis. Almost all HCWs (n = 39/40, 98%) and caregivers (n = 31/34, 91%) felt better/the same about test results after conducting confirmatory testing. CONCLUSION Opportunities remain to strengthen linkage for newly diagnosed CLHIV in Ethiopia through intensifying early follow-up to ensure prompt confirmatory testing and rapid ART initiation. Additional services could help caregivers with decision-making around treatment initiation for their children.
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Affiliation(s)
- Alemayehu Bekele
- grid.428935.10000 0000 9552 339XEthiopian Public Health Association, Addis Ababa, Ethiopia
| | - Susan Hrapcak
- grid.416738.f0000 0001 2163 0069Centers for Disease Control and Prevention, Atlanta, Georgia USA
| | | | - Jemal Ayalew Yimam
- grid.428935.10000 0000 9552 339XEthiopian Public Health Association, Addis Ababa, Ethiopia
| | - Tsegaye Tilahun
- United States Agency for International Development, Addis Ababa, Ethiopia
| | - Tenagnework Antefe
- grid.463120.20000 0004 0455 2507Amhara Regional Health Bureau, Amhara, Ethiopia
| | - Hanna Kumssa
- grid.463056.2Addis Ababa City Administration Health Bureau, Addis Ababa, Ethiopia
| | - Desta Kassa
- grid.452387.f0000 0001 0508 7211Ethiopian Public Health Institute, Addis Ababa, Ethiopia
| | - Semegnew Mengistu
- grid.428935.10000 0000 9552 339XEthiopian Public Health Association, Addis Ababa, Ethiopia
| | - Kelsey Mirkovic
- grid.416738.f0000 0001 2163 0069Centers for Disease Control and Prevention, Atlanta, Georgia USA
| | - Eric J. Dziuban
- grid.416738.f0000 0001 2163 0069Centers for Disease Control and Prevention, Atlanta, Georgia USA
| | - Zena Belay
- grid.416738.f0000 0001 2163 0069Centers for Disease Control and Prevention, Atlanta, Georgia USA
| | - Christine Ross
- Centers for Disease Control and Prevention, Addis Ababa, Ethiopia
| | - Wondimu Teferi
- Centers for Disease Control and Prevention, Addis Ababa, Ethiopia
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Bantie B, Kassaw Yirga G, Abate MW, Amare AT, Nigat AB, Tigabu A, Kerebeh G, Emiru TD, Tibebu NS, Tiruneh CM, Misganaw NM, Temesgen D, Bizuayehu MA, Nuru A, Hiruy EG, Kassaw A. Delayed ART initiation in "Test and Treat era" and its associated factors among adults receiving antiretroviral therapy at public health institutions in Northwest Ethiopia: A multicenter cross-sectional study. PLoS One 2022; 17:e0271127. [PMID: 35877661 PMCID: PMC9312408 DOI: 10.1371/journal.pone.0271127] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2021] [Accepted: 06/23/2022] [Indexed: 11/30/2022] Open
Abstract
BACKGROUND Antiretroviral therapy (ART) has shown promising effects on the reduction of new HIV infection as well as HIV-related morbidity and mortality. In order to boost the effect of ART on ending HIV epidemics by 2030, the World Health Organization (WHO) indeed introduced a universal test and treat strategy in 2015 that recommends rapid (within seven days) initiation of ART for all HIV-positive patients. However, in low-income countries, a substantial number of HIV-positive patients were not enrolled in time, and information on delayed ART initiation status in Ethiopia is limited. METHOD A multicenter cross-sectional study was conducted on 400 HIV-positive adults receiving ART at public health institutions in Bahir Dar city, Northwest Ethiopia. A structured checklist was used to extract data from the patient's medical record. Data was entered into Epi-data version 4.6 and exported to SPSS version 26 for further analysis. Both simple and multivariable binary logistic regressions were executed, and variables with a p-value < 0.05 in the final model were considered significant predictors of delayed ART initiation. RESULTS The magnitude of delayed ART initiation was 39% (95% CI: 34%-44%). Being male [Adjusted odds ratio(AOR) = 1.99, 95%CI:1.3-3.2], having opportunistic infections (OIs) [AOR = 2.50, 95%CI:1.4-4.6], having other chronic diseases [AOR = 3.70,95%CI:1.7-8.3], substance abuse [AOR = 3.79, 95%CI: 1.9-7.4], having ambulatory functional status [AOR = 5.38, 95%CI: 1.4-9.6] and didn't have other HIV-positive family member [AOR = 1.85, 95%CI: 1.2-2.9] increases the odds of delayed ART initiation. CONCLUSION AND RECOMMENDATION The burden of delayed ART initiation is found to be high. The presence of OIs and other chronic problems, substance abuse, ambulatory functional status, being male, and not having other HIV-positive family members were identified as significant predictors of delayed ART initiation. Special emphasis needs to be considered for those individuals with the identified risk factors.
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Affiliation(s)
- Berihun Bantie
- Department of Comprehensive Nursing, College of Health Science, Debre Tabor University Northwest Ethiopia, Debra Tabor, Ethiopia
| | - Gebrie Kassaw Yirga
- Department of Comprehensive Nursing, College of Health Science, Debre Tabor University Northwest Ethiopia, Debra Tabor, Ethiopia
| | - Moges Wubneh Abate
- Department of Comprehensive Nursing, College of Health Science, Debre Tabor University Northwest Ethiopia, Debra Tabor, Ethiopia
| | - Abreham Tsedalu Amare
- Department of Comprehensive Nursing, College of Health Science, Debre Tabor University Northwest Ethiopia, Debra Tabor, Ethiopia
| | - Adane Birhanu Nigat
- Department of Comprehensive Nursing, College of Health Science, Debre Tabor University Northwest Ethiopia, Debra Tabor, Ethiopia
| | - Agmasie Tigabu
- Department of Comprehensive Nursing, College of Health Science, Debre Tabor University Northwest Ethiopia, Debra Tabor, Ethiopia
| | - Gashaw Kerebeh
- Department of Pediatrics and Child Health, College of Health Science, Debre Tabor University, Debra Tabor, Northwest Ethiopia
| | - Tigabu Desie Emiru
- Department of Pediatrics and Child Health, College of Health Science, Debre Tabor University, Debra Tabor, Northwest Ethiopia
| | - Nigusie Selomon Tibebu
- Department of Pediatrics and Child Health, College of Health Science, Debre Tabor University, Debra Tabor, Northwest Ethiopia
| | - Chalie Marew Tiruneh
- Department of Pediatrics and Child Health, College of Health Science, Debre Tabor University, Debra Tabor, Northwest Ethiopia
| | - Natnael Moges Misganaw
- Department of Pediatrics and Child Health, College of Health Science, Debre Tabor University, Debra Tabor, Northwest Ethiopia
| | - Dessie Temesgen
- Department of Nursing, College of Health Science, Woldia University, Weldiya, Northeast Ethiopia
| | - Molla Azmeraw Bizuayehu
- Department of Nursing, College of Health Science, Woldia University, Weldiya, Northeast Ethiopia
| | - Ahmed Nuru
- Department of Nursing, College of Medicine and Health Science, Wolkite University, Welkite, Southern Ethiopia
| | - Endalk Getasew Hiruy
- Department of Professional Nurse Specialty, Saint Peters Comprehensive Specialized Hospital, Addis Ababa, Ethiopia
| | - Amare Kassaw
- Department of Pediatrics and Child Health, College of Health Science, Debre Tabor University, Debra Tabor, Northwest Ethiopia
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Subronto YW, Kusmayanti NA, Januraga PP, Dewa Wirawan LN, Wisaksana R, Sukmaningrum E, Kawi NH, Iskandar S, Mulyani T, Sulaiman N, Magnani R, Kaldor J, Law M. Simplified clinical algorithm for immediate antiretroviral therapy initiation: The HATI [HIV awal (early) Test & Treat in Indonesia] implementation research in Indonesia. Indian J Med Res 2022; 156:729-741. [PMID: 37056072 DOI: 10.4103/ijmr.ijmr_239_23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/15/2023] Open
Abstract
Background & objectives Although the World Health Organization recommends same day or rapid (< seven days) antiretroviral therapy (ART) initiation, delays in ART initiation remain common due to waiting for laboratory test results. This study employed a simplified clinical algorithm the HATI [HIV Awal (Early) Test & Treat Indonesia]-SAI (Simple ART Initiation) aimed to increase the proportion of ART uptake and decrease the time to ART initiation that can be used in various care settings. Methods This study compared the percentage of ART uptake and retention, viral load (VL) suppression and time to ART initiation between the observation and intervention phases among newly diagnosed HIV patients from key populations. As part of the intervention, the newly diagnosed patients underwent screening using a simple form [consisting of data on age, height and weight (for body mass index calculation), questions on the presence of symptoms of HIV stages 1 and 2, tuberculosis, history of diabetes, hypertension and kidney disease], to determine eligibility for immediate ART initiation. Those who met the pre-defined criteria immediately received a combination of tenofovir lamivudine and efavirenz for two weeks. The baseline laboratory examination due to this was moved up to two weeks post ART. Factors significantly associated with ART uptake were also determined and their odds ratios were measured using logistic regression analysis. Results A total of 2173 people newly diagnosed with HIV were recruited, with 1579 and 594 in the observation and intervention phases, respectively. In both phases, the majority were men who have sex with men, who were young (<30 yr old) and employed, with high levels of education. The intervention phase significantly increased the proportion of ART initiation [91%, 95% confidence interval (CI): 89-93% vs. 78%, 95% CI: 76-80%] but did not have any impact on the proportion of six months retention and VL suppression. The intervention also significantly decreased the time to ART initiation from median ± interquartile range: 9±20 days to 2±10 days. Interpretation & conclusions The findings of this study suggest that the HATI-SAI intervention increased the uptake and decreased the time for immediate ART initiation. The HATI-SAI provides a simple and safe clinical approach that can readily be adopted in different settings without a costly investment in technology.
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Affiliation(s)
- Yanri Wijayanti Subronto
- Center for Tropical Medicine; Department of Internal Medicine, Division of Tropical Medicine & Infectious Diseases, Faculty of Medicine, Public Health, & Nursing, Gadjah Mada University, Yogyakarta, Indonesia
| | | | - Pande Putu Januraga
- Center for Public Health Innovation, Faculty of Medicine, Udayana University, Bandung, Indonesia
| | | | - Rudi Wisaksana
- Research Center for Care and Control of Infectious Disease, Faculty of Medicine, Padjajaran University, Bandung, Indonesia
| | - Evi Sukmaningrum
- Department of Psychology; Centre of Excellence Health Policy and HIV-AIDS, Jakarta, Indonesia
| | | | - Shelly Iskandar
- Research Center for Care and Control of Infectious Disease, Faculty of Medicine, Padjajaran University, Bandung, Indonesia
| | - Tri Mulyani
- Research Center for Care and Control of Infectious Disease, Faculty of Medicine, Padjajaran University, Bandung, Indonesia
| | - Nurjannah Sulaiman
- Indonesia Ministry of Health, Directorate Communicable Disease Control, Sydney, New South Wales, Australia
| | - Robert Magnani
- HIV-AIDS Research Centre, Atma Jaya Catholic University of Indonesia, Jakarta, Indonesia
| | - John Kaldor
- Kirby Institute, University of New South Wales, Sydney, New South Wales, Australia
| | - Matthew Law
- Kirby Institute, University of New South Wales, Sydney, New South Wales, Australia
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Parcesepe AM, Filiatreau LM, Ebasone PV, Dzudie A, Pence BW, Wainberg M, Yotebieng M, Anastos K, Pefura-Yone E, Ajeh R, Nash D. Mental health and initiation of antiretroviral treatment at enrolment into HIV care in Cameroon under a national "treat all" policy: a cross-sectional analysis. J Int AIDS Soc 2021; 24:e25842. [PMID: 34811945 PMCID: PMC8609224 DOI: 10.1002/jia2.25842] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2021] [Accepted: 10/13/2021] [Indexed: 11/18/2022] Open
Abstract
Introduction Rapid antiretroviral treatment (ART) initiation reduces time from HIV infection to viral suppression, decreasing HIV transmission risk. Mental health symptoms may influence timing of ART initiation. This study estimated the prevalence of ART initiation at enrolment into HIV care and the relationship between mental health and ART initiation at enrolment into HIV care. Methods We conducted interviews with 426 individuals initiating HIV care in Cameroon between June 2019 and March 2020 to estimate the association between mental health and timing of ART initiation. Depression (Patient Health Questionnaire‐9; cut‐point 10), anxiety (Generalized Anxiety Disorder‐7; cut‐point 10), post‐traumatic stress disorder (PTSD) (PTSD Checklist for DSM‐5; cut‐point 31) and harmful alcohol use (Alcohol Use Disorders Identification Test; cut‐point 16) were dichotomized to represent those with and without each exposure at first HIV care appointment. Date of ART initiation (date ART prescribed) was ascertained from medical records. Separate multivariable log‐binomial regression models were used to estimate the association between mental health exposures and ART initiation at enrolment into care. Results and discussion Overall, 87% initiated ART at enrolment into HIV care. Approximately 20% reported depressive symptoms, 15% reported PTSD symptoms, 12% reported anxiety symptoms and 13% reported harmful alcohol use. In multivariable analyses, individuals with moderate to severe depressive symptoms had 1.7 (95% confidence interval [CI] 1.1, 2.7) times the prevalence of not initiating ART at enrolment into HIV care compared to those with no or mild depressive symptoms. Those with symptoms of PTSD, compared to those without, had 1.9 (95% CI 1.2, 2.9) times the prevalence of not initiating ART at enrolment into HIV care. Symptoms of anxiety or harmful drinking were not associated with ART initiation at enrolment into HIV care in multivariable models. Conclusions Symptoms of depression and PTSD were associated with lower prevalence of ART initiation at enrolment into HIV care among this sample of individuals initiating HIV care in Cameroon under a “treat all” policy. Research should examine barriers to timely ART initiation, whether incorporating mental health services into HIV care improves timely ART initiation, and whether untreated symptoms of depression and PTSD drive suboptimal HIV care outcomes.
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Affiliation(s)
- Angela M Parcesepe
- Department of Maternal and Child Health, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA.,University of North Carolina at Chapel Hill, Carolina Population Center, Chapel Hill, North Carolina, USA
| | - Lindsey M Filiatreau
- Gillings School of Global Public Health, Department of Epidemiology, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | | | - Anastase Dzudie
- Clinical Research Education Networking and Consultancy, Yaounde, Cameroon
| | - Brian W Pence
- Gillings School of Global Public Health, Department of Epidemiology, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Milton Wainberg
- Department of Psychiatry, New York State Psychiatric Institute and Columbia University, New York, New York, USA
| | - Marcel Yotebieng
- Department of Medicine, Albert Einstein College of Medicine, Bronx, New York, USA
| | - Kathryn Anastos
- Departments of Medicine and Epidemiology & Population Health, Albert Einstein College of Medicine, Bronx, New York, USA
| | | | - Rogers Ajeh
- Clinical Research Education Networking and Consultancy, Yaounde, Cameroon
| | - Denis Nash
- City University of New York, Institute of Implementation Science in Population Health, Graduate School of Public Health and Health Policy, New York, New York, USA
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7
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Bayisa L, Abera T, Mulisa D, Mosisa G, Mosisa A, Tolosa T, Turi E, Wakuma B, Abdisa E, Bayisa D. Time to Antiretroviral Therapy Initiation and Its Predictors Among Newly Diagnosed HIV-Positive People in Nekemte Town, Western Ethiopia: Claim of Universal Test and Treat. HIV AIDS (Auckl) 2021; 13:959-972. [PMID: 34675687 PMCID: PMC8519411 DOI: 10.2147/hiv.s327967] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2021] [Accepted: 09/26/2021] [Indexed: 11/24/2022] Open
Abstract
Background HIV continuum of care demands early ART initiation for all HIV-infected individuals. Early ART initiation reduces onward HIV transmission facilitating rapid viral suppression. Despite this, delayed ART use is a challenge among newly diagnosed HIV-positive individuals, and there is limited evidence on time to ART initiation among this group in Ethiopia. Thus, this study aimed to assess time to ART initiation and its predictors among newly diagnosed HIV-positive individuals in Nekemte town, Western Ethiopia. Methods An institution-based retrospective follow-up study was conducted on 518 newly diagnosed HIV-positive people from September 5, 2016 to December 20, 2020 at Nekemte town, Western Ethiopia. Data were collected from ART intake forms, registration log books and patient charts. The collected data were entered into Epi Data version 3.1 and STATA version 14.0 was used for analysis. Survival probability was checked graphically by Kaplan–Meier curve and statistically by Log rank test. Both bivariable and multivariable Cox Proportional hazards regression models were conducted to identify the predictors of ART initiation. Hazard ratio with 95% CI and p-value of <0.05 was used to declare a statistical significance. Results By the end of the follow-up, 371 (71.6%) individuals had initiated ART with an overall incidence rate of 51.9 per 1000 [95% CI: 54.07–66.32] person days; median time to ART initiation was 4 [IQR: 1–9] days. Being female (AHR = 1.33, 95% CI: 1.06–1.67), urban dwellers (AHR = 2.02, 95% CI: 1.37–2.97), having baseline OIs (AHR = 1.62, 95% CI: 1.60–4.30); being tested via VCT (AHR = 1.33, 95% CI: 1.02–1.74); linked from OPD (AHR = 0.64, 95% CI: 0.47–0.85); disclosing HIV sero-status (AHR = 2.07, 95% CI: 1.17–3.68); and college and above education level (AHR = 1.43, 95% CI: 1.00–2.0) were identified as significant predictors of early initiation of ART. Conclusion The proportion and incidence of ART initiation was high; a short median time to ART initiation was revealed in this study. Strictly screening OIs, encouraging HIV sero-status disclosure and voluntary HIV testing are recommended to increase early ART initiation.
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Affiliation(s)
- Lami Bayisa
- Department of Nursing, Institute of Health Sciences, Wollega University, Nekemte, Ethiopia
- Correspondence: Lami Bayisa Department of Nursing, Institutes of Health Sciences, Wollega University, P.O. Box: 395, Nekemte, EthiopiaTel +251 924318135 Email
| | - Tesfaye Abera
- Department of Nursing, Institute of Health Sciences, Wollega University, Nekemte, Ethiopia
| | - Diriba Mulisa
- Department of Nursing, Institute of Health Sciences, Wollega University, Nekemte, Ethiopia
| | - Getu Mosisa
- Department of Nursing, Institute of Health Sciences, Wollega University, Nekemte, Ethiopia
| | - Alemnesh Mosisa
- Department of Nursing, Institute of Health Sciences, Wollega University, Nekemte, Ethiopia
| | - Tadesse Tolosa
- Department of Public Health, Institutes of Health Sciences, Wollega University, Nekemte, Ethiopia
| | - Ebisa Turi
- Department of Public Health, Institutes of Health Sciences, Wollega University, Nekemte, Ethiopia
| | - Bizuneh Wakuma
- Department of Pediatric Nursing, Institutes of Health Sciences, Wollega University, Nekemte, Ethiopia
| | - Eba Abdisa
- Department of Nursing, Institute of Health Sciences, Wollega University, Nekemte, Ethiopia
| | - Diriba Bayisa
- Department of Midwifery, Institutes of Health Sciences, Wollega University, Nekemte, Ethiopia
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