Time from HIV diagnosis to commencement of antiretroviral therapy as an indicator to supplement the HIV cascade: Dramatic fall from 2011 to 2015
The HIV care cascade is increasingly used to evaluate HIV treatment programs at the population level. However, the cascade indicators lack the ability to show changes over time, which reduces their utility to guide health policy. Alternatives have been proposed but are complex or result in a delay i...
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| creator | Medland, Nicholas A Chow, Eric P F McMahon, James H Elliott, Julian H Hoy, Jennifer F Fairley, Christopher K |
| description | The HIV care cascade is increasingly used to evaluate HIV treatment programs at the population level. However, the cascade indicators lack the ability to show changes over time, which reduces their utility to guide health policy. Alternatives have been proposed but are complex or result in a delay in results. We propose a new indicator of ART uptake, the time from HIV diagnosis to commencement of ART, and compare it to the existing cascade indicator of proportion of patients on treatment and the WHO proposed cohort cascade indicator of proportion of patients on treatment within one year of diagnosis.
Records from patients from the two largest HIV treatment centres in the state of Victoria, Australia (Melbourne Sexual Health Centre and The Alfred Hospital Department of Infectious Diseases) from 2011 to 2015 were extracted. The intervals between date of diagnosis, entry into care and initiation of ART were compared.
From 2011 to 2015 the proportion of in-care patients who were on ART rose from 87% to 93% (p |
| doi_str_mv | 10.1371/journal.pone.0177634 |
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Records from patients from the two largest HIV treatment centres in the state of Victoria, Australia (Melbourne Sexual Health Centre and The Alfred Hospital Department of Infectious Diseases) from 2011 to 2015 were extracted. The intervals between date of diagnosis, entry into care and initiation of ART were compared.
From 2011 to 2015 the proportion of in-care patients who were on ART rose from 87% to 93% (p<0.0001). From 2011 to 2014, the proportion of patients in care and on ART within one year of diagnosis increased from 43.4% to 78.9% (p = 0.001). The median time from diagnosis to ART fell from 418 days (IQR: 91-1176) to 77 days (IQR: 39-290)(p<0.001) by calendar year in which ART was commenced.
From 2011 to 2015 there were substantial and clinically important falls in the median time from diagnosis to commencing ART in those that commenced ART. The size of this dramatic change was not apparent when only reporting the proportion of patients on ART. Time to ART is a useful indicator and can be used to supplement existing cascade indicators in measuring progress toward universal ART coverage.</description><identifier>ISSN: 1932-6203</identifier><identifier>EISSN: 1932-6203</identifier><identifier>DOI: 10.1371/journal.pone.0177634</identifier><identifier>PMID: 28520807</identifier><language>eng</language><publisher>United States: Public Library of Science</publisher><subject>Acquired immune deficiency syndrome ; Adolescents ; Adult ; Adults ; AIDS ; Analysis ; Antiretroviral agents ; Antiretroviral drugs ; Antiretroviral therapy ; Antiretroviral Therapy, Highly Active ; Asymptomatic infection ; Biology and Life Sciences ; Cascades ; CD4 antigen ; CD4 Lymphocyte Count ; Clinical trials ; Colleges & universities ; Conferences ; Consolidation ; Data sources ; Diagnosis ; Disease Management ; Disease prevention ; Disease transmission ; Dosage and administration ; Drug therapy ; Female ; Guidelines ; Health policy ; Health risks ; Health surveillance ; HIV ; HIV Infections - diagnosis ; HIV Infections - drug therapy ; HIV Infections - epidemiology ; Hospitals ; Human immunodeficiency virus ; Humans ; Incidence ; Indicators ; Infections ; Infectious diseases ; Information dissemination ; Male ; Medical diagnosis ; Medicine ; Medicine and Health Sciences ; Middle Aged ; Objectives ; People and Places ; Populations ; Prevention ; Public health ; Quality Indicators, Health Care ; Receiving ; Risk ; Sexual health ; Sexually transmitted diseases ; STD ; Surveillance ; Therapy ; Time-to-Treatment ; Trends</subject><ispartof>PloS one, 2017-05, Vol.12 (5), p.e0177634-e0177634</ispartof><rights>COPYRIGHT 2017 Public Library of Science</rights><rights>2017 Medland et al. This is an open access article distributed under the terms of the Creative Commons Attribution License: http://creativecommons.org/licenses/by/4.0/ (the “License”), which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited. Notwithstanding the ProQuest Terms and Conditions, you may use this content in accordance with the terms of the License.</rights><rights>2017 Medland et al 2017 Medland et al</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c692t-9aa6ee3f8b3ee1424999ca7f4b60b2ce7e83f0e0384e57659aafba5d9adab3283</citedby><cites>FETCH-LOGICAL-c692t-9aa6ee3f8b3ee1424999ca7f4b60b2ce7e83f0e0384e57659aafba5d9adab3283</cites><orcidid>0000-0003-0403-8930</orcidid></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktopdf>$$Uhttps://www.ncbi.nlm.nih.gov/pmc/articles/PMC5433736/pdf/$$EPDF$$P50$$Gpubmedcentral$$Hfree_for_read</linktopdf><linktohtml>$$Uhttps://www.ncbi.nlm.nih.gov/pmc/articles/PMC5433736/$$EHTML$$P50$$Gpubmedcentral$$Hfree_for_read</linktohtml><link.rule.ids>230,314,724,777,781,861,882,2096,2915,23847,27905,27906,53772,53774,79349,79350</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/28520807$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><contributor>Paraskevis, Dimitrios</contributor><creatorcontrib>Medland, Nicholas A</creatorcontrib><creatorcontrib>Chow, Eric P F</creatorcontrib><creatorcontrib>McMahon, James H</creatorcontrib><creatorcontrib>Elliott, Julian H</creatorcontrib><creatorcontrib>Hoy, Jennifer F</creatorcontrib><creatorcontrib>Fairley, Christopher K</creatorcontrib><title>Time from HIV diagnosis to commencement of antiretroviral therapy as an indicator to supplement the HIV cascade: Dramatic fall from 2011 to 2015</title><title>PloS one</title><addtitle>PLoS One</addtitle><description>The HIV care cascade is increasingly used to evaluate HIV treatment programs at the population level. However, the cascade indicators lack the ability to show changes over time, which reduces their utility to guide health policy. Alternatives have been proposed but are complex or result in a delay in results. We propose a new indicator of ART uptake, the time from HIV diagnosis to commencement of ART, and compare it to the existing cascade indicator of proportion of patients on treatment and the WHO proposed cohort cascade indicator of proportion of patients on treatment within one year of diagnosis.
Records from patients from the two largest HIV treatment centres in the state of Victoria, Australia (Melbourne Sexual Health Centre and The Alfred Hospital Department of Infectious Diseases) from 2011 to 2015 were extracted. The intervals between date of diagnosis, entry into care and initiation of ART were compared.
From 2011 to 2015 the proportion of in-care patients who were on ART rose from 87% to 93% (p<0.0001). From 2011 to 2014, the proportion of patients in care and on ART within one year of diagnosis increased from 43.4% to 78.9% (p = 0.001). The median time from diagnosis to ART fell from 418 days (IQR: 91-1176) to 77 days (IQR: 39-290)(p<0.001) by calendar year in which ART was commenced.
From 2011 to 2015 there were substantial and clinically important falls in the median time from diagnosis to commencing ART in those that commenced ART. The size of this dramatic change was not apparent when only reporting the proportion of patients on ART. Time to ART is a useful indicator and can be used to supplement existing cascade indicators in measuring progress toward universal ART coverage.</description><subject>Acquired immune deficiency syndrome</subject><subject>Adolescents</subject><subject>Adult</subject><subject>Adults</subject><subject>AIDS</subject><subject>Analysis</subject><subject>Antiretroviral agents</subject><subject>Antiretroviral drugs</subject><subject>Antiretroviral therapy</subject><subject>Antiretroviral Therapy, Highly Active</subject><subject>Asymptomatic infection</subject><subject>Biology and Life Sciences</subject><subject>Cascades</subject><subject>CD4 antigen</subject><subject>CD4 Lymphocyte Count</subject><subject>Clinical trials</subject><subject>Colleges & universities</subject><subject>Conferences</subject><subject>Consolidation</subject><subject>Data sources</subject><subject>Diagnosis</subject><subject>Disease Management</subject><subject>Disease prevention</subject><subject>Disease transmission</subject><subject>Dosage and administration</subject><subject>Drug therapy</subject><subject>Female</subject><subject>Guidelines</subject><subject>Health policy</subject><subject>Health risks</subject><subject>Health surveillance</subject><subject>HIV</subject><subject>HIV Infections - diagnosis</subject><subject>HIV Infections - drug therapy</subject><subject>HIV Infections - epidemiology</subject><subject>Hospitals</subject><subject>Human immunodeficiency virus</subject><subject>Humans</subject><subject>Incidence</subject><subject>Indicators</subject><subject>Infections</subject><subject>Infectious diseases</subject><subject>Information dissemination</subject><subject>Male</subject><subject>Medical diagnosis</subject><subject>Medicine</subject><subject>Medicine and Health Sciences</subject><subject>Middle Aged</subject><subject>Objectives</subject><subject>People and Places</subject><subject>Populations</subject><subject>Prevention</subject><subject>Public health</subject><subject>Quality Indicators, Health Care</subject><subject>Receiving</subject><subject>Risk</subject><subject>Sexual health</subject><subject>Sexually transmitted diseases</subject><subject>STD</subject><subject>Surveillance</subject><subject>Therapy</subject><subject>Time-to-Treatment</subject><subject>Trends</subject><issn>1932-6203</issn><issn>1932-6203</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2017</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><sourceid>ABUWG</sourceid><sourceid>AFKRA</sourceid><sourceid>AZQEC</sourceid><sourceid>BENPR</sourceid><sourceid>CCPQU</sourceid><sourceid>DWQXO</sourceid><sourceid>GNUQQ</sourceid><sourceid>DOA</sourceid><recordid>eNqNk9tu1DAQhiMEoqXwBggiISG42MWnxDEXSFU5dKVKlaD01po49q6rJA62U9G34JFxuttqg3rBTRx5vv-fzEwmy15itMSU4w9XbvQ9tMvB9XqJMOclZY-yQywoWZQE0cd77wfZsxCuECpoVZZPswNSFQRViB9mfy5sp3PjXZefri7zxsK6d8GGPLpcua7TvdLpEXNncuij9Tp6d209tHncaA_DTQ4hRXLbN1ZBdH5ShnEY2q0uUbfOCoKCRn_MP3voIFqVG2jbbWaCMJ5k6SyeZ09SIOgXu_Mo-_n1y8XJ6eLs_Nvq5PhsoUpB4kIAlFpTU9VUa8wIE0Io4IbVJaqJ0lxX1CCNaMV0wcsi8aaGohHQQE1JRY-y11vfoXVB7poZJK6EoLzEhCVitSUaB1dy8LYDfyMdWHl74fxagk-FtFqyokwjIUZRohihqOYG1YJXQhnGm0Ynr0-7bGPd6UalzqQWzkznkd5u5Npdy4JRymmZDN7tDLz7NeoQZWeD0m0LvXZj-m6BUEW5YDihb_5BH65uR60hFWB741JeNZnKYyZwRVJamqjlAxRMk-ysSn-esel-Jng_EyQm6t9xDWMIcvXj-_-z55dz9u0eu9HQxk1w7Rit68McZFtQeReC1-a-yRjJaXHuuiGnxZG7xUmyV_sDuhfdbQr9C_5EExk</recordid><startdate>20170516</startdate><enddate>20170516</enddate><creator>Medland, 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from HIV diagnosis to commencement of antiretroviral therapy as an indicator to supplement the HIV cascade: Dramatic fall from 2011 to 2015</title><author>Medland, Nicholas A ; Chow, Eric P F ; McMahon, James H ; Elliott, Julian H ; Hoy, Jennifer F ; Fairley, Christopher K</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c692t-9aa6ee3f8b3ee1424999ca7f4b60b2ce7e83f0e0384e57659aafba5d9adab3283</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2017</creationdate><topic>Acquired immune deficiency syndrome</topic><topic>Adolescents</topic><topic>Adult</topic><topic>Adults</topic><topic>AIDS</topic><topic>Analysis</topic><topic>Antiretroviral agents</topic><topic>Antiretroviral drugs</topic><topic>Antiretroviral therapy</topic><topic>Antiretroviral Therapy, Highly Active</topic><topic>Asymptomatic infection</topic><topic>Biology and Life Sciences</topic><topic>Cascades</topic><topic>CD4 antigen</topic><topic>CD4 Lymphocyte Count</topic><topic>Clinical trials</topic><topic>Colleges & universities</topic><topic>Conferences</topic><topic>Consolidation</topic><topic>Data sources</topic><topic>Diagnosis</topic><topic>Disease Management</topic><topic>Disease prevention</topic><topic>Disease transmission</topic><topic>Dosage and administration</topic><topic>Drug therapy</topic><topic>Female</topic><topic>Guidelines</topic><topic>Health policy</topic><topic>Health risks</topic><topic>Health surveillance</topic><topic>HIV</topic><topic>HIV Infections - diagnosis</topic><topic>HIV Infections - drug therapy</topic><topic>HIV Infections - epidemiology</topic><topic>Hospitals</topic><topic>Human immunodeficiency virus</topic><topic>Humans</topic><topic>Incidence</topic><topic>Indicators</topic><topic>Infections</topic><topic>Infectious diseases</topic><topic>Information dissemination</topic><topic>Male</topic><topic>Medical diagnosis</topic><topic>Medicine</topic><topic>Medicine 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indicator to supplement the HIV cascade: Dramatic fall from 2011 to 2015</atitle><jtitle>PloS one</jtitle><addtitle>PLoS One</addtitle><date>2017-05-16</date><risdate>2017</risdate><volume>12</volume><issue>5</issue><spage>e0177634</spage><epage>e0177634</epage><pages>e0177634-e0177634</pages><issn>1932-6203</issn><eissn>1932-6203</eissn><abstract>The HIV care cascade is increasingly used to evaluate HIV treatment programs at the population level. However, the cascade indicators lack the ability to show changes over time, which reduces their utility to guide health policy. Alternatives have been proposed but are complex or result in a delay in results. We propose a new indicator of ART uptake, the time from HIV diagnosis to commencement of ART, and compare it to the existing cascade indicator of proportion of patients on treatment and the WHO proposed cohort cascade indicator of proportion of patients on treatment within one year of diagnosis.
Records from patients from the two largest HIV treatment centres in the state of Victoria, Australia (Melbourne Sexual Health Centre and The Alfred Hospital Department of Infectious Diseases) from 2011 to 2015 were extracted. The intervals between date of diagnosis, entry into care and initiation of ART were compared.
From 2011 to 2015 the proportion of in-care patients who were on ART rose from 87% to 93% (p<0.0001). From 2011 to 2014, the proportion of patients in care and on ART within one year of diagnosis increased from 43.4% to 78.9% (p = 0.001). The median time from diagnosis to ART fell from 418 days (IQR: 91-1176) to 77 days (IQR: 39-290)(p<0.001) by calendar year in which ART was commenced.
From 2011 to 2015 there were substantial and clinically important falls in the median time from diagnosis to commencing ART in those that commenced ART. The size of this dramatic change was not apparent when only reporting the proportion of patients on ART. Time to ART is a useful indicator and can be used to supplement existing cascade indicators in measuring progress toward universal ART coverage.</abstract><cop>United States</cop><pub>Public Library of Science</pub><pmid>28520807</pmid><doi>10.1371/journal.pone.0177634</doi><tpages>e0177634</tpages><orcidid>https://orcid.org/0000-0003-0403-8930</orcidid><oa>free_for_read</oa></addata></record> |
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| ispartof | PloS one, 2017-05, Vol.12 (5), p.e0177634-e0177634 |
| issn | 1932-6203 1932-6203 |
| language | eng |
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| source | MEDLINE; DOAJ Directory of Open Access Journals; Public Library of Science (PLoS); EZB-FREE-00999 freely available EZB journals; PubMed Central; Free Full-Text Journals in Chemistry |
| subjects | Acquired immune deficiency syndrome Adolescents Adult Adults AIDS Analysis Antiretroviral agents Antiretroviral drugs Antiretroviral therapy Antiretroviral Therapy, Highly Active Asymptomatic infection Biology and Life Sciences Cascades CD4 antigen CD4 Lymphocyte Count Clinical trials Colleges & universities Conferences Consolidation Data sources Diagnosis Disease Management Disease prevention Disease transmission Dosage and administration Drug therapy Female Guidelines Health policy Health risks Health surveillance HIV HIV Infections - diagnosis HIV Infections - drug therapy HIV Infections - epidemiology Hospitals Human immunodeficiency virus Humans Incidence Indicators Infections Infectious diseases Information dissemination Male Medical diagnosis Medicine Medicine and Health Sciences Middle Aged Objectives People and Places Populations Prevention Public health Quality Indicators, Health Care Receiving Risk Sexual health Sexually transmitted diseases STD Surveillance Therapy Time-to-Treatment Trends |
| title | Time from HIV diagnosis to commencement of antiretroviral therapy as an indicator to supplement the HIV cascade: Dramatic fall from 2011 to 2015 |
| url | https://sfx.bib-bvb.de/sfx_tum?ctx_ver=Z39.88-2004&ctx_enc=info:ofi/enc:UTF-8&ctx_tim=2025-01-19T20%3A37%3A13IST&url_ver=Z39.88-2004&url_ctx_fmt=infofi/fmt:kev:mtx:ctx&rfr_id=info:sid/primo.exlibrisgroup.com:primo3-Article-gale_plos_&rft_val_fmt=info:ofi/fmt:kev:mtx:journal&rft.genre=article&rft.atitle=Time%20from%20HIV%20diagnosis%20to%20commencement%20of%20antiretroviral%20therapy%20as%20an%20indicator%20to%20supplement%20the%20HIV%20cascade:%20Dramatic%20fall%20from%202011%20to%202015&rft.jtitle=PloS%20one&rft.au=Medland,%20Nicholas%20A&rft.date=2017-05-16&rft.volume=12&rft.issue=5&rft.spage=e0177634&rft.epage=e0177634&rft.pages=e0177634-e0177634&rft.issn=1932-6203&rft.eissn=1932-6203&rft_id=info:doi/10.1371/journal.pone.0177634&rft_dat=%3Cgale_plos_%3EA491823733%3C/gale_plos_%3E%3Curl%3E%3C/url%3E&disable_directlink=true&sfx.directlink=off&sfx.report_link=0&rft_id=info:oai/&rft_pqid=1899376124&rft_id=info:pmid/28520807&rft_galeid=A491823733&rft_doaj_id=oai_doaj_org_article_4563712fc32c4230b7f0b9789cf47dde&rfr_iscdi=true |