Accelerating the Uptake and Timing of Antiretroviral Therapy Initiation in Sub-Saharan Africa: An Operations Research Agenda

The highest priority is to evaluate whether a simplified clinical algorithm in patients who have tested positive for HIV can safely identify patients who should and should not start ART immediately without awaiting further laboratory test results, followed by determining the optimal speed of initiation and how to streamline clinic operations to make initiation more efficient. * Proposed standardized outcomes to measure in research on models of treatment initiation include ART initiation within 28 days of first HIV-related clinic visit, six-month retention in care (clinic visit within 90 days of the expected six-month visit after initiation), and early viral suppression (suppressed viral load within 28 days of the expected first routine viral load test). (PDF) Acknowledgments Participants in the MATI technical consultation were David Allen (Bill & Melinda Gates Foundation), Ruanne Barnabas (University of Washington), Peter Ehrenkranz (Bill & Melinda Gates Foundation), Nathan Ford (WHO), Matthew Fox (Boston University), Tendani Gaolathe (Princess Marina Hospital, Botswana) Kenneth Gimbel-Sherr (University of Washington), Anna Grimsrud (International AIDS Society), Charles Holmes (Center for Infectious Disease Research in Zambia), Jonathan Kaplan (unaffiliated), Carol Langley (Office of the U.S. Global AIDS Coordinator), Bruce Larson (Boston University), Yukari Manabe (Johns Hopkins University), Ribakare Muhayimpundu (Ministry of Health, Rwanda), John Nkengasong (U.S. Centers for Disease Control and Prevention), Constance Nyamukapa (Imperial College London), Olarotimi Oladoyinbo (U.S. Agency for International Development), Meg Osler (University of Cape Town), Yogan Pillay (National Department of Health, South Africa), Annette Reinisch (The Global Fund), Paul Revill (University of York), Sydney Rosen (Boston University), Lesley Scott (National Health Laboratory Service, South Africa), Zara Shubber (The World Bank), Morten Skovdal (University of Copenhagen), Salif Sow (Bill & Melinda Gates Foundation), Wendy Stevens (National Health Laboratory Service, South Africa), Francois Venter (Wits Reproductive Health and HIV Institute), Peter Vranken (U.S. Centers for Disease Control and Prevention), Juddy Wachira (Moi University), Rhoda Wanyenze (Makerere University), Lynne Wilkinson (Médecins Sans Frontières), and Isaac Zulu (U.S. Centers for Disease Control and Prevention).