Rapid antiretroviral therapy initiation reduces attrition between HIV testing and treatment in Africa

By  Sydney Rosen  Dr Mhairi Maskew  Matthew Fox  Cynthia Nyoni  Constance Mongwenyana  Given Malete  Professor Ian Sanne  Dorah Bokaba  Lawrence Long  Celeste Sauls, Julia Rohr  |  | 

Abstract 

Background: Very high rates of patient attrition from HIV care between HIV testing and antiretroviral therapy (ART) initiation have been documented in sub-Saharan Africa. Accelerating the steps required for ART initiation has been proposed to reduce attrition and achieve earlier treatment initiation. Methods: The RapIT study evaluated the effect of immediate ART initiation on ART uptake and retention in a COJ clinic and hospital. Non-pregnant adults receiving a positive HIV test or first CD4 count were randomized to standard initiation (3-4 clinic visits prior to ARV dispensing) or rapid initiation with point-of-care CD4 count, blood tests, and TB test if symptomatic; physical examination; accelerated education/counseling; and same-day ART dispensing. Treatment was initiated by a PHN and counselor; similar to those employed by COJ. Results: 174 patients were randomized to rapid and 182 to standard initiation. In both groups, 83% of patients newly diagnosed HIV+ were already eligible for ART. In the rapid group, 97% initiated treatment <1 month, compared to 54% in the standard group. All rapid group patients who did not initiate <1 month (n=5) were required to delay ART for TB treatment. At the three-month point, 98% of those who initiated in both groups were retained on ART. Treatment initiation took an average of 2.8 hours for rapid group patients not requiring Xpert. Conclusions: Immediate ART initiation using rapid tests and accelerated procedures is feasible and acceptable in public sector clinics and reduces pre-ART loss to follow up significantly. It should be considered for adoption in high-volume clinics.

Conference: COJ conference 2014, Johannesburg, South Africa

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