Cover Image

CD4+ T-cell count at antiretroviral therapy initiation in the "treat all" era in rural South Africa: an interrupted time series analysis

BACKGROUND: South Africa implemented universal test and treat (UTT) in September 2016 in an effort to encourage earlier initiation of antiretroviral therapy (ART). - METHODS: We therefore conducted an interrupted time series (ITS) analysis to assess the impact of UTT on mean CD4 count at ART initiat...

Full description

Saved in:
Bibliographic Details
Main Authors: Yapa, H. Manisha (Author) , Kim, Hae-Young (Author) , Petoumenos, Kathy (Author) , Post, Frank A. (Author) , Jiamsakul, Awachana (Author) , De Neve, Jan-Walter (Author) , Tanser, Frank (Author) , Iwuji, Collins (Author) , Baisley, Kathy (Author) , Shahmanesh, Maryam (Author) , Pillay, Deenan (Author) , Siedner, Mark J. (Author) , Bärnighausen, Till (Author) , Bor, Jacob (Author)
Format: Article (Journal)
Language:English
Published: 26 July 2021
In: Clinical infectious diseases
Year: 2021, Pages: 1-26
ISSN:1537-6591
Online Access: Get full text
Author Notes:H. Manisha Yapa, Hae-Young Kim, Kathy Petoumenos, Frank A. Post, Awachana Jiamsakul, Jan-Walter De Neve, Frank Tanser, Collins Iwuji, Kathy Baisley, Maryam Shahmanesh, Deenan Pillay, Mark J. Siedner, Till Bärnighausen, Jacob Bor
Description
Summary:BACKGROUND: South Africa implemented universal test and treat (UTT) in September 2016 in an effort to encourage earlier initiation of antiretroviral therapy (ART). - METHODS: We therefore conducted an interrupted time series (ITS) analysis to assess the impact of UTT on mean CD4 count at ART initiation among adults ≥16 years old attending 17 public sector primary care services in rural South Africa between July 2014 and March 2019. - RESULTS: Among 20,599 individuals (69% women), CD4 counts were available for 74%. Mean CD4 at ART initiation increased from 317.1 cells/μL (95% confidence interval, CI, 308.6 to 325.6)-one to eight months prior to UTT-to 421.0 cells/μL (95% CI 413.0 to 429.0) one to twelve months after UTT, including an immediate increase of 124.2 cells/μL (95% CI 102.2 to 146.1). However, mean CD4 count subsequently fell to 389.5 cells/μL (95% CI 381.8 to 397.1) 13 to 30 months after UTT, but remained above pre-UTT levels. Men initiated ART at lower CD4 counts than women (-118.2 cells/μL, 95% CI -125.5 to -111.0) throughout the study. - CONCLUSIONS: Although UTT led to an immediate increase in CD4 count at ART initiation in this rural community, the long-term effects were modest. More efforts are needed to increase initiation of ART early in HIV infection, particularly among men.
Item Description:Gesehen am 09.08.2021
Physical Description:Online Resource
ISSN:1537-6591

Similar Items