HIV test-and-treat policy improves clinical outcomes in Zambian adults from Southern Province: a multicenter retrospective cohort study
BackgroundGlobally, most countries have implemented a test-and-treat policy to reduce morbidity and mortality associated with HIV infection. However, the impact of this strategy has not been critically appraised in many settings, including Zambia. We evaluated the retention and clinical outcomes of...
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| Format: | Article |
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Frontiers Media S.A.
2023-10-01
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| Series: | Frontiers in Public Health |
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| Online Access: | https://www.frontiersin.org/articles/10.3389/fpubh.2023.1244125/full |
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| author | Benson M. Hamooya Simon Mutembo Brian Muyunda Keith Mweebo Nzali Kancheya Lyapa Sikazwe Morgan Sakala Johanzi Mvula Salazeh Kunda Shem Kabesha Chilala Cheelo Isaac Fwemba Clive Banda Sepiso K. Masenga |
| author_facet | Benson M. Hamooya Simon Mutembo Brian Muyunda Keith Mweebo Nzali Kancheya Lyapa Sikazwe Morgan Sakala Johanzi Mvula Salazeh Kunda Shem Kabesha Chilala Cheelo Isaac Fwemba Clive Banda Sepiso K. Masenga |
| author_sort | Benson M. Hamooya |
| collection | DOAJ |
| description | BackgroundGlobally, most countries have implemented a test-and-treat policy to reduce morbidity and mortality associated with HIV infection. However, the impact of this strategy has not been critically appraised in many settings, including Zambia. We evaluated the retention and clinical outcomes of adults enrolled in antiretroviral therapy (ART) and assessed the impact of the test-and-treat policy.MethodsWe conducted a retrospective cohort study among 6,640 individuals who initiated ART between January 1, 2014 and July 31, 2016 [before test-and-treat cohort (BTT), n = 2,991] and between August 1, 2016 and October 1, 2020 [after test-and-treat cohort (ATT), n = 3,649] in 12 districts of the Southern province. To assess factors associated with retention, we used logistic regression (xtlogit model).ResultsThe median age [interquartile range (IQR)] was 34.8 years (28.0, 42.1), and 60.2% (n = 3,995) were women. The overall retention was 83.4% [95% confidence interval (CI) 82.6, 84.4], and it was significantly higher among the ATT cohort, 90.6 vs. 74.8%, p < 0.001. The reasons for attrition were higher in the BTT compared to the ATT cohorts: stopped treatment (0.3 vs. 0.1%), transferred out (9.3 vs. 3.2%), lost to follow-up (13.5 vs. 5.9%), and death (1.4 vs. 0.2%). Retention in care was significantly associated with the ATT cohort, increasing age and baseline body mass index (BMI), rural residence, and WHO stage 2, while non-retention was associated with never being married, divorced, and being in WHO stage 3.ConclusionThe retention rate and attrition factors improved in the ATT compared to the BTT cohorts. Drivers of retention were test-and-treat policy, older age, high BMI, rural residence, marital status, and WHO stage 1. Therefore, there is need for interventions targeting young people, urban residents, non-married people, and those in the symptomatic WHO stages and with low BMI. Our findings highlight improved ART retention after the implementation of the test-and-treat policy. |
| first_indexed | 2024-03-11T18:52:34Z |
| format | Article |
| id | doaj.art-57b88c728cdd4741aadd01caff0838f6 |
| institution | Directory Open Access Journal |
| issn | 2296-2565 |
| language | English |
| last_indexed | 2024-03-11T18:52:34Z |
| publishDate | 2023-10-01 |
| publisher | Frontiers Media S.A. |
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| series | Frontiers in Public Health |
| spelling | doaj.art-57b88c728cdd4741aadd01caff0838f62023-10-11T07:54:30ZengFrontiers Media S.A.Frontiers in Public Health2296-25652023-10-011110.3389/fpubh.2023.12441251244125HIV test-and-treat policy improves clinical outcomes in Zambian adults from Southern Province: a multicenter retrospective cohort studyBenson M. Hamooya0Simon Mutembo1Brian Muyunda2Keith Mweebo3Nzali Kancheya4Lyapa Sikazwe5Morgan Sakala6Johanzi Mvula7Salazeh Kunda8Shem Kabesha9Chilala Cheelo10Isaac Fwemba11Clive Banda12Sepiso K. Masenga13School of Medicine and Health Sciences, Mulungushi University, Livingstone, ZambiaInternational Vaccine Access Center, Department of International Health, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, United StatesCenters for Disease Control and Prevention, Lusaka, ZambiaCenters for Disease Control and Prevention, Lusaka, ZambiaCenters for Disease Control and Prevention, Lusaka, ZambiaProvincial Medical Office, Ministry of Health, Choma, ZambiaProvincial Medical Office, Ministry of Health, Choma, ZambiaProvincial Medical Office, Ministry of Health, Choma, ZambiaProvincial Medical Office, Ministry of Health, Choma, ZambiaProvincial Medical Office, Ministry of Health, Choma, ZambiaSchool of Medicine and Health Sciences, Mulungushi University, Livingstone, ZambiaSchool of Public Health, University of Zambia, Lusaka, ZambiaProvincial Medical Office, Ministry of Health, Choma, ZambiaSchool of Medicine and Health Sciences, Mulungushi University, Livingstone, ZambiaBackgroundGlobally, most countries have implemented a test-and-treat policy to reduce morbidity and mortality associated with HIV infection. However, the impact of this strategy has not been critically appraised in many settings, including Zambia. We evaluated the retention and clinical outcomes of adults enrolled in antiretroviral therapy (ART) and assessed the impact of the test-and-treat policy.MethodsWe conducted a retrospective cohort study among 6,640 individuals who initiated ART between January 1, 2014 and July 31, 2016 [before test-and-treat cohort (BTT), n = 2,991] and between August 1, 2016 and October 1, 2020 [after test-and-treat cohort (ATT), n = 3,649] in 12 districts of the Southern province. To assess factors associated with retention, we used logistic regression (xtlogit model).ResultsThe median age [interquartile range (IQR)] was 34.8 years (28.0, 42.1), and 60.2% (n = 3,995) were women. The overall retention was 83.4% [95% confidence interval (CI) 82.6, 84.4], and it was significantly higher among the ATT cohort, 90.6 vs. 74.8%, p < 0.001. The reasons for attrition were higher in the BTT compared to the ATT cohorts: stopped treatment (0.3 vs. 0.1%), transferred out (9.3 vs. 3.2%), lost to follow-up (13.5 vs. 5.9%), and death (1.4 vs. 0.2%). Retention in care was significantly associated with the ATT cohort, increasing age and baseline body mass index (BMI), rural residence, and WHO stage 2, while non-retention was associated with never being married, divorced, and being in WHO stage 3.ConclusionThe retention rate and attrition factors improved in the ATT compared to the BTT cohorts. Drivers of retention were test-and-treat policy, older age, high BMI, rural residence, marital status, and WHO stage 1. Therefore, there is need for interventions targeting young people, urban residents, non-married people, and those in the symptomatic WHO stages and with low BMI. Our findings highlight improved ART retention after the implementation of the test-and-treat policy.https://www.frontiersin.org/articles/10.3389/fpubh.2023.1244125/fullretentionHIVtestingantiretroviral therapyZambiaclinical outcomes |
| spellingShingle | Benson M. Hamooya Simon Mutembo Brian Muyunda Keith Mweebo Nzali Kancheya Lyapa Sikazwe Morgan Sakala Johanzi Mvula Salazeh Kunda Shem Kabesha Chilala Cheelo Isaac Fwemba Clive Banda Sepiso K. Masenga HIV test-and-treat policy improves clinical outcomes in Zambian adults from Southern Province: a multicenter retrospective cohort study Frontiers in Public Health retention HIV testing antiretroviral therapy Zambia clinical outcomes |
| title | HIV test-and-treat policy improves clinical outcomes in Zambian adults from Southern Province: a multicenter retrospective cohort study |
| title_full | HIV test-and-treat policy improves clinical outcomes in Zambian adults from Southern Province: a multicenter retrospective cohort study |
| title_fullStr | HIV test-and-treat policy improves clinical outcomes in Zambian adults from Southern Province: a multicenter retrospective cohort study |
| title_full_unstemmed | HIV test-and-treat policy improves clinical outcomes in Zambian adults from Southern Province: a multicenter retrospective cohort study |
| title_short | HIV test-and-treat policy improves clinical outcomes in Zambian adults from Southern Province: a multicenter retrospective cohort study |
| title_sort | hiv test and treat policy improves clinical outcomes in zambian adults from southern province a multicenter retrospective cohort study |
| topic | retention HIV testing antiretroviral therapy Zambia clinical outcomes |
| url | https://www.frontiersin.org/articles/10.3389/fpubh.2023.1244125/full |
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