Expansion and scale-up of HIV care and treatment services in four countries over ten years.
BACKGROUND:Scale-up and expansion of antiretroviral therapy (ART) for people living with HIV (PLHIV) have been a global priority for more than 15 years. METHODS:We describe PLHIV at enrollment in care and ART initiation in Ethiopia, Kenya, Mozambique and Tanzania from 2005-2014 and report on enrollm...
| Main Authors: | , , , , , , , , , |
|---|---|
| Format: | Article |
| Language: | English |
| Published: |
Public Library of Science (PLoS)
2020-01-01
|
| Series: | PLoS ONE |
| Online Access: | https://doi.org/10.1371/journal.pone.0231667 |
| _version_ | 1818833823700353024 |
|---|---|
| author | Chloe A Teasdale Elaine J Abrams Katharine A Yuengling Matthew R Lamb Chunhui Wang Mirriah Vitale Mark Hawken Zenebe Melaku Harriet Nuwagaba-Biribonwoha Wafaa M El-Sadr |
| author_facet | Chloe A Teasdale Elaine J Abrams Katharine A Yuengling Matthew R Lamb Chunhui Wang Mirriah Vitale Mark Hawken Zenebe Melaku Harriet Nuwagaba-Biribonwoha Wafaa M El-Sadr |
| author_sort | Chloe A Teasdale |
| collection | DOAJ |
| description | BACKGROUND:Scale-up and expansion of antiretroviral therapy (ART) for people living with HIV (PLHIV) have been a global priority for more than 15 years. METHODS:We describe PLHIV at enrollment in care and ART initiation in Ethiopia, Kenya, Mozambique and Tanzania from 2005-2014 and report on enrollment location, CD4 count and loss to follow-up (LTF), death, and combined attrition (LTF and death) pre- and post-ART initiation over time. Pre-ART outcomes were estimated using competing risk and post-ART using Kaplan-Meier estimators; LTF defined as no visit within six months pre-ART and 12 months after ART start. RESULTS:From 2005-2014, 884,328 PLHIV enrolled in care at 350 health facilities, median age was 32.0 years (interquartile range [IQR] 26.0-42.0), and majority were female (66.5%). The proportion of PLHIV enrolled at primary and rural facilities increased from 12.9% and 15.3% in 2005-2006 to 43.5% and 41.7% in 2013-2014 (p<0.0001). Median CD4+ cell count at enrollment increased from 171 cell/mm3 in 2005-2006 (IQR 71-339) to 289 cell/mm3 in 2013-2014 (IQR 133-485) (p<0.0001). A total of 460,758 (57.4%) PLHIV initiated treatment. Cumulative risk of LTF for PLHIV prior to ART initiation 12 months after enrollment was 33.5% (95%CI 33.36-33.58) and 21.98% (95%CI 21.9-22.1) after ART initiation. Pregnant women and the youngest PLHIV group had the highest attrition after ART initiation, at 24 months 40.8% (95%CI 40.1-41.6) of pregnant women and 47.4% (95%CI 46.4-48.4) of PLHIV 15-19 years were not retained. Attrition at 12 months after enrollment among PLHIV regardless of ART status was 38.5% (95%CI 38.4-38.6). CONCLUSION:Over 10 years of HIV scale-up in four sub-Saharan African countries, close to a million PLHIV were enrolled in care increasingly at rural and primary facilities with increasing CD4 count. Loss to follow-up from HIV care remains alarmingly high, particularly among pregnant women and younger PLHIV. |
| first_indexed | 2024-12-19T02:25:03Z |
| format | Article |
| id | doaj.art-1acc149be373488a892f691cae27853e |
| institution | Directory Open Access Journal |
| issn | 1932-6203 |
| language | English |
| last_indexed | 2024-12-19T02:25:03Z |
| publishDate | 2020-01-01 |
| publisher | Public Library of Science (PLoS) |
| record_format | Article |
| series | PLoS ONE |
| spelling | doaj.art-1acc149be373488a892f691cae27853e2022-12-21T20:39:58ZengPublic Library of Science (PLoS)PLoS ONE1932-62032020-01-01154e023166710.1371/journal.pone.0231667Expansion and scale-up of HIV care and treatment services in four countries over ten years.Chloe A TeasdaleElaine J AbramsKatharine A YuenglingMatthew R LambChunhui WangMirriah VitaleMark HawkenZenebe MelakuHarriet Nuwagaba-BiribonwohaWafaa M El-SadrBACKGROUND:Scale-up and expansion of antiretroviral therapy (ART) for people living with HIV (PLHIV) have been a global priority for more than 15 years. METHODS:We describe PLHIV at enrollment in care and ART initiation in Ethiopia, Kenya, Mozambique and Tanzania from 2005-2014 and report on enrollment location, CD4 count and loss to follow-up (LTF), death, and combined attrition (LTF and death) pre- and post-ART initiation over time. Pre-ART outcomes were estimated using competing risk and post-ART using Kaplan-Meier estimators; LTF defined as no visit within six months pre-ART and 12 months after ART start. RESULTS:From 2005-2014, 884,328 PLHIV enrolled in care at 350 health facilities, median age was 32.0 years (interquartile range [IQR] 26.0-42.0), and majority were female (66.5%). The proportion of PLHIV enrolled at primary and rural facilities increased from 12.9% and 15.3% in 2005-2006 to 43.5% and 41.7% in 2013-2014 (p<0.0001). Median CD4+ cell count at enrollment increased from 171 cell/mm3 in 2005-2006 (IQR 71-339) to 289 cell/mm3 in 2013-2014 (IQR 133-485) (p<0.0001). A total of 460,758 (57.4%) PLHIV initiated treatment. Cumulative risk of LTF for PLHIV prior to ART initiation 12 months after enrollment was 33.5% (95%CI 33.36-33.58) and 21.98% (95%CI 21.9-22.1) after ART initiation. Pregnant women and the youngest PLHIV group had the highest attrition after ART initiation, at 24 months 40.8% (95%CI 40.1-41.6) of pregnant women and 47.4% (95%CI 46.4-48.4) of PLHIV 15-19 years were not retained. Attrition at 12 months after enrollment among PLHIV regardless of ART status was 38.5% (95%CI 38.4-38.6). CONCLUSION:Over 10 years of HIV scale-up in four sub-Saharan African countries, close to a million PLHIV were enrolled in care increasingly at rural and primary facilities with increasing CD4 count. Loss to follow-up from HIV care remains alarmingly high, particularly among pregnant women and younger PLHIV.https://doi.org/10.1371/journal.pone.0231667 |
| spellingShingle | Chloe A Teasdale Elaine J Abrams Katharine A Yuengling Matthew R Lamb Chunhui Wang Mirriah Vitale Mark Hawken Zenebe Melaku Harriet Nuwagaba-Biribonwoha Wafaa M El-Sadr Expansion and scale-up of HIV care and treatment services in four countries over ten years. PLoS ONE |
| title | Expansion and scale-up of HIV care and treatment services in four countries over ten years. |
| title_full | Expansion and scale-up of HIV care and treatment services in four countries over ten years. |
| title_fullStr | Expansion and scale-up of HIV care and treatment services in four countries over ten years. |
| title_full_unstemmed | Expansion and scale-up of HIV care and treatment services in four countries over ten years. |
| title_short | Expansion and scale-up of HIV care and treatment services in four countries over ten years. |
| title_sort | expansion and scale up of hiv care and treatment services in four countries over ten years |
| url | https://doi.org/10.1371/journal.pone.0231667 |
| work_keys_str_mv | AT chloeateasdale expansionandscaleupofhivcareandtreatmentservicesinfourcountriesovertenyears AT elainejabrams expansionandscaleupofhivcareandtreatmentservicesinfourcountriesovertenyears AT katharineayuengling expansionandscaleupofhivcareandtreatmentservicesinfourcountriesovertenyears AT matthewrlamb expansionandscaleupofhivcareandtreatmentservicesinfourcountriesovertenyears AT chunhuiwang expansionandscaleupofhivcareandtreatmentservicesinfourcountriesovertenyears AT mirriahvitale expansionandscaleupofhivcareandtreatmentservicesinfourcountriesovertenyears AT markhawken expansionandscaleupofhivcareandtreatmentservicesinfourcountriesovertenyears AT zenebemelaku expansionandscaleupofhivcareandtreatmentservicesinfourcountriesovertenyears AT harrietnuwagababiribonwoha expansionandscaleupofhivcareandtreatmentservicesinfourcountriesovertenyears AT wafaamelsadr expansionandscaleupofhivcareandtreatmentservicesinfourcountriesovertenyears |