Medication Side Effects and Retention in HIV Treatment: A Regression Discontinuity Study of Tenofovir Implementation in South Africa and Zambia

By  Alana Brennan  Jacob Bor  Mary-Ann Davies, Gilles Wandeler, Hans Prozesky, Geoffrey Fatti, Robin Wood, Kathryn Stinson, Frank Tanser, Till Bärnighausen, Andrew Boulle, Izukanji Sikazwe, Arianna Zanolini,  Matthew Fox  |  | 

We assessed the impact of national guideline changes in South Africa (2010) and Zambia (2007) recommending tenofovir for first-line ART. We
applied regression discontinuity in a prospective cohort study of 52,294 HIV-infected adults initiating first-line ART within 12months (±12 months) of each guideline change.We compared outcomes in patients presenting just before and afterthe guideline changes using local linear regression and estimated intention-to-treat effects on initiation of tenofovir, retention in care, and other treatment outcomes at 24 months. We assessed complier causal effects among patients starting tenofovir.