Feasibility of implementing same-day antiretroviral therapy initiation during routine care in Ekurhuleni District, South Africa: Retention and viral load suppression
Background: Same-day initiation (SDI) of antiretroviral therapy (ART) has been advocated as an approach to increase linkage to care and overall ART initiation. Clinical trials have demonstrated impressive benefits. However, questions regarding patient preparedness and retention in care remain for ro...
| Main Authors: | , , , , , , , |
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| Format: | Article |
| Language: | English |
| Published: |
AOSIS
2020-08-01
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| Series: | Southern African Journal of HIV Medicine |
| Subjects: | |
| Online Access: | https://sajhivmed.org.za/index.php/hivmed/article/view/1085 |
| _version_ | 1828340100741726208 |
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| author | Nolundi Mshweshwe-Pakela Bhakti Hansoti Tonderai Mabuto Deanna Kerrigan Griffiths Kubeka Elizabeth Hahn Salome Charalambous Christopher J. Hoffmann |
| author_facet | Nolundi Mshweshwe-Pakela Bhakti Hansoti Tonderai Mabuto Deanna Kerrigan Griffiths Kubeka Elizabeth Hahn Salome Charalambous Christopher J. Hoffmann |
| author_sort | Nolundi Mshweshwe-Pakela |
| collection | DOAJ |
| description | Background: Same-day initiation (SDI) of antiretroviral therapy (ART) has been advocated as an approach to increase linkage to care and overall ART initiation. Clinical trials have demonstrated impressive benefits. However, questions regarding patient preparedness and retention in care remain for routine implementation of this approach.
Objectives: In this study, we sought to describe SDI of ART during routine care delivery and compare time to ART initiation on longitudinal care outcomes.
Method: We performed a retrospective chart review of 100 consecutive individuals, newly diagnosed with HIV, from 10 health facilities across Ekurhuleni, from January to July 2017. Records were reviewed for a period of 1 year post-diagnosis. Abstracted data included demographics, time to ART initiation, clinic visits and laboratory test results (including viral load testing).
Results: A total of 993 patient records were reviewed, of which 826 were included in the analysis. The majority of patients (752, 91%) had ART initiation recorded, of which 654 (79%) had ART initiated within 30 days, and 224 (27%) had SDI. Uptake of SDI of ART was higher among women (36% vs. 10.4%; p 0.001) and in younger patients (33.7% in those 29 years; p 0.01). Retention in care at 6 months was achieved in 477 (58%) patients. Of those with 6-month viral loads, 350/430 (73%) had a viral load 400 c/m. Retention in care and viral suppression were similar among those with SDI of ART and later ART initiation.
Conclusion: Same-day initiation of ART was successfully delivered with similar retention and viral load outcomes as subsequent initiation, providing re-assurance for scale-up of this strategy in routine care. |
| first_indexed | 2024-04-13T22:52:25Z |
| format | Article |
| id | doaj.art-77d0be11e1d7496bb0e2815e5bbe723f |
| institution | Directory Open Access Journal |
| issn | 1608-9693 2078-6751 |
| language | English |
| last_indexed | 2024-04-13T22:52:25Z |
| publishDate | 2020-08-01 |
| publisher | AOSIS |
| record_format | Article |
| series | Southern African Journal of HIV Medicine |
| spelling | doaj.art-77d0be11e1d7496bb0e2815e5bbe723f2022-12-22T02:26:09ZengAOSISSouthern African Journal of HIV Medicine1608-96932078-67512020-08-01211e1e610.4102/sajhivmed.v21i1.1085697Feasibility of implementing same-day antiretroviral therapy initiation during routine care in Ekurhuleni District, South Africa: Retention and viral load suppressionNolundi Mshweshwe-Pakela0Bhakti Hansoti1Tonderai Mabuto2Deanna Kerrigan3Griffiths Kubeka4Elizabeth Hahn5Salome Charalambous6Christopher J. Hoffmann7Implementation Research Division, The Aurum Institute, JohannesburgDepartment of Emergency Medicine, Johns Hopkins School of Medicine, Baltimore, United States of America; and, Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, United States of AmericaImplementation Research Division, The Aurum Institute, Johannesburg, South Africa; and, School of Public Health, University of the Witwatersrand, JohannesburgDepartment of Sociology, American University, Washington, United States of AmericaImplementation Research Division, The Aurum Institute, JohannesburgDepartment of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, United States of AmericaImplementation Research Division, The Aurum Institute, Johannesburg, South Africa; and, School of Public Health, University of the Witwatersrand, JohannesburgImplementation Research Division, The Aurum Institute, Johannesburg, South Africa; and, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, United States of America; and, Department of Health, Behavior, and Society, Johns Hopkins Bloomberg School of Public Health, Baltimore, United States of AmericaBackground: Same-day initiation (SDI) of antiretroviral therapy (ART) has been advocated as an approach to increase linkage to care and overall ART initiation. Clinical trials have demonstrated impressive benefits. However, questions regarding patient preparedness and retention in care remain for routine implementation of this approach. Objectives: In this study, we sought to describe SDI of ART during routine care delivery and compare time to ART initiation on longitudinal care outcomes. Method: We performed a retrospective chart review of 100 consecutive individuals, newly diagnosed with HIV, from 10 health facilities across Ekurhuleni, from January to July 2017. Records were reviewed for a period of 1 year post-diagnosis. Abstracted data included demographics, time to ART initiation, clinic visits and laboratory test results (including viral load testing). Results: A total of 993 patient records were reviewed, of which 826 were included in the analysis. The majority of patients (752, 91%) had ART initiation recorded, of which 654 (79%) had ART initiated within 30 days, and 224 (27%) had SDI. Uptake of SDI of ART was higher among women (36% vs. 10.4%; p 0.001) and in younger patients (33.7% in those 29 years; p 0.01). Retention in care at 6 months was achieved in 477 (58%) patients. Of those with 6-month viral loads, 350/430 (73%) had a viral load 400 c/m. Retention in care and viral suppression were similar among those with SDI of ART and later ART initiation. Conclusion: Same-day initiation of ART was successfully delivered with similar retention and viral load outcomes as subsequent initiation, providing re-assurance for scale-up of this strategy in routine care.https://sajhivmed.org.za/index.php/hivmed/article/view/1085hiv testingprimary caresdiarv initiationimplementation |
| spellingShingle | Nolundi Mshweshwe-Pakela Bhakti Hansoti Tonderai Mabuto Deanna Kerrigan Griffiths Kubeka Elizabeth Hahn Salome Charalambous Christopher J. Hoffmann Feasibility of implementing same-day antiretroviral therapy initiation during routine care in Ekurhuleni District, South Africa: Retention and viral load suppression Southern African Journal of HIV Medicine hiv testing primary care sdi arv initiation implementation |
| title | Feasibility of implementing same-day antiretroviral therapy initiation during routine care in Ekurhuleni District, South Africa: Retention and viral load suppression |
| title_full | Feasibility of implementing same-day antiretroviral therapy initiation during routine care in Ekurhuleni District, South Africa: Retention and viral load suppression |
| title_fullStr | Feasibility of implementing same-day antiretroviral therapy initiation during routine care in Ekurhuleni District, South Africa: Retention and viral load suppression |
| title_full_unstemmed | Feasibility of implementing same-day antiretroviral therapy initiation during routine care in Ekurhuleni District, South Africa: Retention and viral load suppression |
| title_short | Feasibility of implementing same-day antiretroviral therapy initiation during routine care in Ekurhuleni District, South Africa: Retention and viral load suppression |
| title_sort | feasibility of implementing same day antiretroviral therapy initiation during routine care in ekurhuleni district south africa retention and viral load suppression |
| topic | hiv testing primary care sdi arv initiation implementation |
| url | https://sajhivmed.org.za/index.php/hivmed/article/view/1085 |
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