HIV treatment eligibility expansion and timely antiretroviral treatment initiation following enrollment in HIV care: A metaregression analysis of programmatic data from 22 countries
The effect of antiretroviral treatment (ART) eligibility expansions on patient outcomes, including rates of timely ART initiation among those enrolling in care, has not been assessed on a large scale. In addition, it is not known whether ART eligibility expansions may lead to "crowding out"...
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| Veröffentlicht in: | PLoS medicine 2018-03, Vol.15 (3), p.e1002534-e1002534 |
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| creator | Tymejczyk, Olga Brazier, Ellen Yiannoutsos, Constantin Wools-Kaloustian, Kara Althoff, Keri Crabtree-Ramírez, Brenda Van Nguyen, Kinh Zaniewski, Elizabeth Dabis, Francois Sinayobye, Jean d'Amour Anderegg, Nanina Ford, Nathan Wikramanayake, Radhika Nash, Denis |
| description | The effect of antiretroviral treatment (ART) eligibility expansions on patient outcomes, including rates of timely ART initiation among those enrolling in care, has not been assessed on a large scale. In addition, it is not known whether ART eligibility expansions may lead to "crowding out" of sicker patients.
We examined changes in timely ART initiation (within 6 months) at the original site of HIV care enrollment after ART eligibility expansions among 284,740 adult ART-naïve patients at 171 International Epidemiology Databases to Evaluate AIDS (IeDEA) network sites in 22 countries where national policies expanding ART eligibility were introduced between 2007 and 2015. Half of the sites included in this analysis were from Southern Africa, one-third were from East Africa, and the remainder were from the Asia-Pacific, Central Africa, North America, and South and Central America regions. The median age of patients enrolling in care at contributing sites was 33.5 years, and the median percentage of female patients at these clinics was 62.5%. We assessed the 6-month cumulative incidence of timely ART initiation (CI-ART) before and after major expansions of ART eligibility (i.e., expansion to treat persons with CD4 ≤ 350 cells/μL [145 sites in 22 countries] and CD4 ≤ 500 cells/μL [152 sites in 15 countries]). Random effects metaregression models were used to estimate absolute changes in CI-ART at each site before and after guideline expansion. The crude pooled estimate of change in CI-ART was 4.3 percentage points (95% confidence interval [CI] 2.6 to 6.1) after ART eligibility expansion to CD4 ≤ 350, from a baseline median CI-ART of 53%; and 15.9 percentage points (pp) (95% CI 14.3 to 17.4) after ART eligibility expansion to CD4 ≤ 500, from a baseline median CI-ART of 57%. The largest increases in CI-ART were observed among those newly eligible for treatment (18.2 pp after expansion to CD4 ≤ 350 and 47.4 pp after expansion to CD4 ≤ 500), with no change or small increases among those eligible under prior guidelines (CD4 ≤ 350: -0.6 pp, 95% CI -2.0 to 0.7 pp; CD4 ≤ 500: 4.9 pp, 95% CI 3.3 to 6.5 pp). For ART eligibility expansion to CD4 ≤ 500, changes in CI-ART were largest among younger patients (16-24 years: 21.5 pp, 95% CI 18.9 to 24.2 pp). Key limitations include the lack of a counterfactual and difficulty accounting for secular outcome trends, due to universal exposure to guideline changes in each country.
These findings underscore the potential of ART eligi |
| doi_str_mv | 10.1371/journal.pmed.1002534 |
| format | Article |
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We examined changes in timely ART initiation (within 6 months) at the original site of HIV care enrollment after ART eligibility expansions among 284,740 adult ART-naïve patients at 171 International Epidemiology Databases to Evaluate AIDS (IeDEA) network sites in 22 countries where national policies expanding ART eligibility were introduced between 2007 and 2015. Half of the sites included in this analysis were from Southern Africa, one-third were from East Africa, and the remainder were from the Asia-Pacific, Central Africa, North America, and South and Central America regions. The median age of patients enrolling in care at contributing sites was 33.5 years, and the median percentage of female patients at these clinics was 62.5%. We assessed the 6-month cumulative incidence of timely ART initiation (CI-ART) before and after major expansions of ART eligibility (i.e., expansion to treat persons with CD4 ≤ 350 cells/μL [145 sites in 22 countries] and CD4 ≤ 500 cells/μL [152 sites in 15 countries]). Random effects metaregression models were used to estimate absolute changes in CI-ART at each site before and after guideline expansion. The crude pooled estimate of change in CI-ART was 4.3 percentage points (95% confidence interval [CI] 2.6 to 6.1) after ART eligibility expansion to CD4 ≤ 350, from a baseline median CI-ART of 53%; and 15.9 percentage points (pp) (95% CI 14.3 to 17.4) after ART eligibility expansion to CD4 ≤ 500, from a baseline median CI-ART of 57%. The largest increases in CI-ART were observed among those newly eligible for treatment (18.2 pp after expansion to CD4 ≤ 350 and 47.4 pp after expansion to CD4 ≤ 500), with no change or small increases among those eligible under prior guidelines (CD4 ≤ 350: -0.6 pp, 95% CI -2.0 to 0.7 pp; CD4 ≤ 500: 4.9 pp, 95% CI 3.3 to 6.5 pp). For ART eligibility expansion to CD4 ≤ 500, changes in CI-ART were largest among younger patients (16-24 years: 21.5 pp, 95% CI 18.9 to 24.2 pp). Key limitations include the lack of a counterfactual and difficulty accounting for secular outcome trends, due to universal exposure to guideline changes in each country.
These findings underscore the potential of ART eligibility expansion to improve the timeliness of ART initiation globally, particularly for young adults.</description><identifier>ISSN: 1549-1676</identifier><identifier>ISSN: 1549-1277</identifier><identifier>EISSN: 1549-1676</identifier><identifier>DOI: 10.1371/journal.pmed.1002534</identifier><identifier>PMID: 29570723</identifier><language>eng</language><publisher>United States: Public Library of Science</publisher><subject>Acquired immune deficiency syndrome ; Adolescent ; Adult ; AIDS ; Anti-HIV Agents - therapeutic use ; Antiretroviral agents ; Antiretroviral drugs ; Antiretroviral therapy ; Biology and Life Sciences ; Care and treatment ; CD4 antigen ; CD4 Lymphocyte Count ; Collaboration ; Computer and Information Sciences ; Data processing ; Dosage and administration ; Drug therapy ; Epidemiology ; Expansion ; Female ; Health care ; Health Services Accessibility ; HIV ; HIV infections ; HIV Infections - drug therapy ; HIV Infections - epidemiology ; Hospitals ; Human immunodeficiency virus ; Humans ; International Cooperation ; Longitudinal Studies ; Male ; Medical tests ; Medicine and Health Sciences ; Middle Aged ; Patients ; People and Places ; Population ; Preventive medicine ; Prospective Studies ; Public health ; Regression Analysis ; Retrospective Studies ; Systematic review ; Time-to-Treatment ; Tropical diseases ; World Health Organization ; Young Adult ; Young adults</subject><ispartof>PLoS medicine, 2018-03, Vol.15 (3), p.e1002534-e1002534</ispartof><rights>COPYRIGHT 2018 Public Library of Science</rights><rights>2018 Public Library of Science. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited: Tymejczyk O, Brazier E, Yiannoutsos C, Wools-Kaloustian K, Althoff K, Crabtree-Ramírez B, et al. (2018) HIV treatment eligibility expansion and timely antiretroviral treatment initiation following enrollment in HIV care: A metaregression analysis of programmatic data from 22 countries. PLoS Med 15(3): e1002534. https://doi.org/10.1371/journal.pmed.1002534</rights><rights>2018 Tymejczyk et al 2018 Tymejczyk et al</rights><rights>2018 Public Library of Science. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited: Tymejczyk O, Brazier E, Yiannoutsos C, Wools-Kaloustian K, Althoff K, Crabtree-Ramírez B, et al. (2018) HIV treatment eligibility expansion and timely antiretroviral treatment initiation following enrollment in HIV care: A metaregression analysis of programmatic data from 22 countries. 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In addition, it is not known whether ART eligibility expansions may lead to "crowding out" of sicker patients.
We examined changes in timely ART initiation (within 6 months) at the original site of HIV care enrollment after ART eligibility expansions among 284,740 adult ART-naïve patients at 171 International Epidemiology Databases to Evaluate AIDS (IeDEA) network sites in 22 countries where national policies expanding ART eligibility were introduced between 2007 and 2015. Half of the sites included in this analysis were from Southern Africa, one-third were from East Africa, and the remainder were from the Asia-Pacific, Central Africa, North America, and South and Central America regions. The median age of patients enrolling in care at contributing sites was 33.5 years, and the median percentage of female patients at these clinics was 62.5%. We assessed the 6-month cumulative incidence of timely ART initiation (CI-ART) before and after major expansions of ART eligibility (i.e., expansion to treat persons with CD4 ≤ 350 cells/μL [145 sites in 22 countries] and CD4 ≤ 500 cells/μL [152 sites in 15 countries]). Random effects metaregression models were used to estimate absolute changes in CI-ART at each site before and after guideline expansion. The crude pooled estimate of change in CI-ART was 4.3 percentage points (95% confidence interval [CI] 2.6 to 6.1) after ART eligibility expansion to CD4 ≤ 350, from a baseline median CI-ART of 53%; and 15.9 percentage points (pp) (95% CI 14.3 to 17.4) after ART eligibility expansion to CD4 ≤ 500, from a baseline median CI-ART of 57%. The largest increases in CI-ART were observed among those newly eligible for treatment (18.2 pp after expansion to CD4 ≤ 350 and 47.4 pp after expansion to CD4 ≤ 500), with no change or small increases among those eligible under prior guidelines (CD4 ≤ 350: -0.6 pp, 95% CI -2.0 to 0.7 pp; CD4 ≤ 500: 4.9 pp, 95% CI 3.3 to 6.5 pp). For ART eligibility expansion to CD4 ≤ 500, changes in CI-ART were largest among younger patients (16-24 years: 21.5 pp, 95% CI 18.9 to 24.2 pp). Key limitations include the lack of a counterfactual and difficulty accounting for secular outcome trends, due to universal exposure to guideline changes in each country.
These findings underscore the potential of ART eligibility expansion to improve the timeliness of ART initiation globally, particularly for young adults.</description><subject>Acquired immune deficiency syndrome</subject><subject>Adolescent</subject><subject>Adult</subject><subject>AIDS</subject><subject>Anti-HIV Agents - therapeutic use</subject><subject>Antiretroviral agents</subject><subject>Antiretroviral drugs</subject><subject>Antiretroviral therapy</subject><subject>Biology and Life Sciences</subject><subject>Care and treatment</subject><subject>CD4 antigen</subject><subject>CD4 Lymphocyte Count</subject><subject>Collaboration</subject><subject>Computer and Information Sciences</subject><subject>Data processing</subject><subject>Dosage and administration</subject><subject>Drug therapy</subject><subject>Epidemiology</subject><subject>Expansion</subject><subject>Female</subject><subject>Health care</subject><subject>Health Services Accessibility</subject><subject>HIV</subject><subject>HIV infections</subject><subject>HIV Infections - drug therapy</subject><subject>HIV Infections - epidemiology</subject><subject>Hospitals</subject><subject>Human immunodeficiency virus</subject><subject>Humans</subject><subject>International Cooperation</subject><subject>Longitudinal Studies</subject><subject>Male</subject><subject>Medical tests</subject><subject>Medicine and Health Sciences</subject><subject>Middle Aged</subject><subject>Patients</subject><subject>People and Places</subject><subject>Population</subject><subject>Preventive medicine</subject><subject>Prospective Studies</subject><subject>Public health</subject><subject>Regression Analysis</subject><subject>Retrospective Studies</subject><subject>Systematic review</subject><subject>Time-to-Treatment</subject><subject>Tropical diseases</subject><subject>World Health Organization</subject><subject>Young Adult</subject><subject>Young adults</subject><issn>1549-1676</issn><issn>1549-1277</issn><issn>1549-1676</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2018</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>DOA</sourceid><recordid>eNqVk81u1DAQxyMEolB4AwSWkBAcdkliJ445IFUV0JUqKvHRq-U449SVYy-2U7oPxvvh0LTaRXsA5ZCR_Zv_fHmy7FmRLwtMi7eXbvRWmOV6gG5Z5HlZYXIve1RUhC2Kmtb3t-yD7HEIl4lhOcsfZgclq2hOS_wo-3WyOkfRg4gD2IjA6F632ui4QXC9FjZoZ5GwHYp6ALNJZtQeondX2guz5amtjlrECVfOGPdT2x6B9cme79EUSgoP79ARGiAmq_cQ5gjCbIIOyCm09q73YhiSmESdiAIp7wZUlki60UavITzJHihhAjyd_4fZ948fvh2fLE7PPq2Oj04XktYkLkrSUoa7Om8KCak_SuG6ExXDVKqyrhW0BWmI7CgAJky0smEMWE5rJSpJKcWH2Ysb3bVxgc8dD7xMza5ZRUiZiNUN0TlxyddeD8JvuBOa_zlwvufCp0IMcFISQXPVsrLsCBDaNgBECNYVDaO4xUnr_RxtbNNQZWpb6vGO6O6N1Re8d1e8auqKFpPA61nAux8jhMgHHSQYIyy4ccq7aFLqlEyVvfwL3V_dTPUiFaCtcimunET5UYUxJjS9o0Qt9lA9WEhJOgtKp-MdfrmHT18Hg5Z7Hd7sOCQmwnXsxRgCX3398h_s539nz8532Vdb7AUIEy-CM-P04sMuSG5A6V0IHtTdAIucT5t722k-bS6fNze5Pd8e_p3T7ari3zYyQOs</recordid><startdate>20180323</startdate><enddate>20180323</enddate><creator>Tymejczyk, Olga</creator><creator>Brazier, Ellen</creator><creator>Yiannoutsos, Constantin</creator><creator>Wools-Kaloustian, Kara</creator><creator>Althoff, Keri</creator><creator>Crabtree-Ramírez, Brenda</creator><creator>Van Nguyen, Kinh</creator><creator>Zaniewski, Elizabeth</creator><creator>Dabis, Francois</creator><creator>Sinayobye, Jean d'Amour</creator><creator>Anderegg, Nanina</creator><creator>Ford, Nathan</creator><creator>Wikramanayake, Radhika</creator><creator>Nash, Denis</creator><general>Public Library of Science</general><general>Public Library of Science (PLoS)</general><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>IOV</scope><scope>ISN</scope><scope>ISR</scope><scope>3V.</scope><scope>7TK</scope><scope>7X7</scope><scope>7XB</scope><scope>88E</scope><scope>8FI</scope><scope>8FJ</scope><scope>8FK</scope><scope>ABUWG</scope><scope>AFKRA</scope><scope>AZQEC</scope><scope>BENPR</scope><scope>CCPQU</scope><scope>DWQXO</scope><scope>FYUFA</scope><scope>GHDGH</scope><scope>K9.</scope><scope>M0S</scope><scope>M1P</scope><scope>PIMPY</scope><scope>PQEST</scope><scope>PQQKQ</scope><scope>PQUKI</scope><scope>PRINS</scope><scope>7X8</scope><scope>5PM</scope><scope>DOA</scope><scope>CZK</scope><orcidid>https://orcid.org/0000-0002-2587-1123</orcidid><orcidid>https://orcid.org/0000-0003-1986-2359</orcidid><orcidid>https://orcid.org/0000-0002-8417-0650</orcidid><orcidid>https://orcid.org/0000-0002-1614-8857</orcidid></search><sort><creationdate>20180323</creationdate><title>HIV treatment eligibility expansion and timely antiretroviral treatment initiation following enrollment in HIV care: A metaregression analysis of programmatic data from 22 countries</title><author>Tymejczyk, Olga ; Brazier, Ellen ; Yiannoutsos, Constantin ; Wools-Kaloustian, Kara ; Althoff, Keri ; Crabtree-Ramírez, Brenda ; Van Nguyen, Kinh ; Zaniewski, Elizabeth ; Dabis, Francois ; Sinayobye, Jean d'Amour ; Anderegg, Nanina ; Ford, Nathan ; Wikramanayake, Radhika ; Nash, Denis</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c764t-24b793d6081ce253ff36da5937cf266feb1484cd7ee349abc899e9076fa5c7773</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2018</creationdate><topic>Acquired immune deficiency syndrome</topic><topic>Adolescent</topic><topic>Adult</topic><topic>AIDS</topic><topic>Anti-HIV Agents - therapeutic use</topic><topic>Antiretroviral agents</topic><topic>Antiretroviral drugs</topic><topic>Antiretroviral therapy</topic><topic>Biology and Life Sciences</topic><topic>Care and treatment</topic><topic>CD4 antigen</topic><topic>CD4 Lymphocyte Count</topic><topic>Collaboration</topic><topic>Computer and Information Sciences</topic><topic>Data processing</topic><topic>Dosage and administration</topic><topic>Drug therapy</topic><topic>Epidemiology</topic><topic>Expansion</topic><topic>Female</topic><topic>Health care</topic><topic>Health Services Accessibility</topic><topic>HIV</topic><topic>HIV infections</topic><topic>HIV Infections - drug therapy</topic><topic>HIV Infections - epidemiology</topic><topic>Hospitals</topic><topic>Human immunodeficiency virus</topic><topic>Humans</topic><topic>International Cooperation</topic><topic>Longitudinal Studies</topic><topic>Male</topic><topic>Medical tests</topic><topic>Medicine and Health Sciences</topic><topic>Middle Aged</topic><topic>Patients</topic><topic>People and Places</topic><topic>Population</topic><topic>Preventive medicine</topic><topic>Prospective Studies</topic><topic>Public health</topic><topic>Regression Analysis</topic><topic>Retrospective Studies</topic><topic>Systematic review</topic><topic>Time-to-Treatment</topic><topic>Tropical diseases</topic><topic>World Health Organization</topic><topic>Young Adult</topic><topic>Young adults</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Tymejczyk, Olga</creatorcontrib><creatorcontrib>Brazier, Ellen</creatorcontrib><creatorcontrib>Yiannoutsos, Constantin</creatorcontrib><creatorcontrib>Wools-Kaloustian, Kara</creatorcontrib><creatorcontrib>Althoff, Keri</creatorcontrib><creatorcontrib>Crabtree-Ramírez, Brenda</creatorcontrib><creatorcontrib>Van Nguyen, Kinh</creatorcontrib><creatorcontrib>Zaniewski, Elizabeth</creatorcontrib><creatorcontrib>Dabis, Francois</creatorcontrib><creatorcontrib>Sinayobye, Jean d'Amour</creatorcontrib><creatorcontrib>Anderegg, Nanina</creatorcontrib><creatorcontrib>Ford, Nathan</creatorcontrib><creatorcontrib>Wikramanayake, Radhika</creatorcontrib><creatorcontrib>Nash, Denis</creatorcontrib><creatorcontrib>IeDEA Collaboration</creatorcontrib><creatorcontrib>IeDEA Collaboration</creatorcontrib><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>Gale In Context: Opposing Viewpoints</collection><collection>Gale In Context: Canada</collection><collection>Gale In Context: Science</collection><collection>ProQuest Central (Corporate)</collection><collection>Neurosciences Abstracts</collection><collection>Health & Medical Collection</collection><collection>ProQuest Central (purchase pre-March 2016)</collection><collection>Medical Database (Alumni Edition)</collection><collection>Hospital Premium Collection</collection><collection>Hospital Premium Collection (Alumni Edition)</collection><collection>ProQuest Central (Alumni) (purchase pre-March 2016)</collection><collection>ProQuest Central (Alumni Edition)</collection><collection>ProQuest Central UK/Ireland</collection><collection>ProQuest Central Essentials</collection><collection>ProQuest Central</collection><collection>ProQuest One Community College</collection><collection>ProQuest Central Korea</collection><collection>Health Research Premium Collection</collection><collection>Health Research Premium Collection (Alumni)</collection><collection>ProQuest Health & Medical Complete (Alumni)</collection><collection>Health & Medical Collection (Alumni Edition)</collection><collection>Medical Database</collection><collection>Access via ProQuest (Open Access)</collection><collection>ProQuest One Academic Eastern Edition (DO NOT USE)</collection><collection>ProQuest One Academic</collection><collection>ProQuest One Academic UKI Edition</collection><collection>ProQuest Central China</collection><collection>MEDLINE - Academic</collection><collection>PubMed Central (Full Participant titles)</collection><collection>DOAJ Directory of Open Access Journals</collection><collection>PLoS Medicine</collection><jtitle>PLoS medicine</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Tymejczyk, Olga</au><au>Brazier, Ellen</au><au>Yiannoutsos, Constantin</au><au>Wools-Kaloustian, Kara</au><au>Althoff, Keri</au><au>Crabtree-Ramírez, Brenda</au><au>Van Nguyen, Kinh</au><au>Zaniewski, Elizabeth</au><au>Dabis, Francois</au><au>Sinayobye, Jean d'Amour</au><au>Anderegg, Nanina</au><au>Ford, Nathan</au><au>Wikramanayake, Radhika</au><au>Nash, Denis</au><au>Newell, Marie-Louise</au><aucorp>IeDEA Collaboration</aucorp><aucorp>IeDEA Collaboration</aucorp><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>HIV treatment eligibility expansion and timely antiretroviral treatment initiation following enrollment in HIV care: A metaregression analysis of programmatic data from 22 countries</atitle><jtitle>PLoS medicine</jtitle><addtitle>PLoS Med</addtitle><date>2018-03-23</date><risdate>2018</risdate><volume>15</volume><issue>3</issue><spage>e1002534</spage><epage>e1002534</epage><pages>e1002534-e1002534</pages><issn>1549-1676</issn><issn>1549-1277</issn><eissn>1549-1676</eissn><abstract>The effect of antiretroviral treatment (ART) eligibility expansions on patient outcomes, including rates of timely ART initiation among those enrolling in care, has not been assessed on a large scale. In addition, it is not known whether ART eligibility expansions may lead to "crowding out" of sicker patients.
We examined changes in timely ART initiation (within 6 months) at the original site of HIV care enrollment after ART eligibility expansions among 284,740 adult ART-naïve patients at 171 International Epidemiology Databases to Evaluate AIDS (IeDEA) network sites in 22 countries where national policies expanding ART eligibility were introduced between 2007 and 2015. Half of the sites included in this analysis were from Southern Africa, one-third were from East Africa, and the remainder were from the Asia-Pacific, Central Africa, North America, and South and Central America regions. The median age of patients enrolling in care at contributing sites was 33.5 years, and the median percentage of female patients at these clinics was 62.5%. We assessed the 6-month cumulative incidence of timely ART initiation (CI-ART) before and after major expansions of ART eligibility (i.e., expansion to treat persons with CD4 ≤ 350 cells/μL [145 sites in 22 countries] and CD4 ≤ 500 cells/μL [152 sites in 15 countries]). Random effects metaregression models were used to estimate absolute changes in CI-ART at each site before and after guideline expansion. The crude pooled estimate of change in CI-ART was 4.3 percentage points (95% confidence interval [CI] 2.6 to 6.1) after ART eligibility expansion to CD4 ≤ 350, from a baseline median CI-ART of 53%; and 15.9 percentage points (pp) (95% CI 14.3 to 17.4) after ART eligibility expansion to CD4 ≤ 500, from a baseline median CI-ART of 57%. The largest increases in CI-ART were observed among those newly eligible for treatment (18.2 pp after expansion to CD4 ≤ 350 and 47.4 pp after expansion to CD4 ≤ 500), with no change or small increases among those eligible under prior guidelines (CD4 ≤ 350: -0.6 pp, 95% CI -2.0 to 0.7 pp; CD4 ≤ 500: 4.9 pp, 95% CI 3.3 to 6.5 pp). For ART eligibility expansion to CD4 ≤ 500, changes in CI-ART were largest among younger patients (16-24 years: 21.5 pp, 95% CI 18.9 to 24.2 pp). Key limitations include the lack of a counterfactual and difficulty accounting for secular outcome trends, due to universal exposure to guideline changes in each country.
These findings underscore the potential of ART eligibility expansion to improve the timeliness of ART initiation globally, particularly for young adults.</abstract><cop>United States</cop><pub>Public Library of Science</pub><pmid>29570723</pmid><doi>10.1371/journal.pmed.1002534</doi><orcidid>https://orcid.org/0000-0002-2587-1123</orcidid><orcidid>https://orcid.org/0000-0003-1986-2359</orcidid><orcidid>https://orcid.org/0000-0002-8417-0650</orcidid><orcidid>https://orcid.org/0000-0002-1614-8857</orcidid><oa>free_for_read</oa></addata></record> |
| fulltext | fulltext |
| identifier | ISSN: 1549-1676 |
| ispartof | PLoS medicine, 2018-03, Vol.15 (3), p.e1002534-e1002534 |
| issn | 1549-1676 1549-1277 1549-1676 |
| language | eng |
| recordid | cdi_plos_journals_2025695442 |
| source | PubMed Central Free; MEDLINE; DOAJ Directory of Open Access Journals; Public Library of Science (PLoS) Journals Open Access; EZB-FREE-00999 freely available EZB journals |
| subjects | Acquired immune deficiency syndrome Adolescent Adult AIDS Anti-HIV Agents - therapeutic use Antiretroviral agents Antiretroviral drugs Antiretroviral therapy Biology and Life Sciences Care and treatment CD4 antigen CD4 Lymphocyte Count Collaboration Computer and Information Sciences Data processing Dosage and administration Drug therapy Epidemiology Expansion Female Health care Health Services Accessibility HIV HIV infections HIV Infections - drug therapy HIV Infections - epidemiology Hospitals Human immunodeficiency virus Humans International Cooperation Longitudinal Studies Male Medical tests Medicine and Health Sciences Middle Aged Patients People and Places Population Preventive medicine Prospective Studies Public health Regression Analysis Retrospective Studies Systematic review Time-to-Treatment Tropical diseases World Health Organization Young Adult Young adults |
| title | HIV treatment eligibility expansion and timely antiretroviral treatment initiation following enrollment in HIV care: A metaregression analysis of programmatic data from 22 countries |
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