Uptake and effect of universal test-and-treat on twelve months retention and initial virologic suppression in routine HIV program in Kenya.
Early combination antiretroviral therapy (cART), as recommended in WHO's universal test-and-treat (UTT) policy, is associated with improved linkage to care, retention, and virologic suppression in controlled studies. We aimed to describe UTT uptake and effect on twelve-month non-retention and i...
| Main Authors: | , , , , , , , , , , , , , |
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| Format: | Article |
| Language: | English |
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Public Library of Science (PLoS)
2022-01-01
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| Series: | PLoS ONE |
| Online Access: | https://doi.org/10.1371/journal.pone.0277675 |
| _version_ | 1797959178352852992 |
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| author | Davies O Kimanga Violet A Oramisi Amin S Hassan Mary K Mugambi Frederick O Miruka Kennedy J Muthoka Jacob O Odhiambo Peter K Yegon Gonza O Omoro Catherine Mbaire Kenneth M Masamaro Susan M Njogo Joseph L Barker Catherine N Ngugi |
| author_facet | Davies O Kimanga Violet A Oramisi Amin S Hassan Mary K Mugambi Frederick O Miruka Kennedy J Muthoka Jacob O Odhiambo Peter K Yegon Gonza O Omoro Catherine Mbaire Kenneth M Masamaro Susan M Njogo Joseph L Barker Catherine N Ngugi |
| author_sort | Davies O Kimanga |
| collection | DOAJ |
| description | Early combination antiretroviral therapy (cART), as recommended in WHO's universal test-and-treat (UTT) policy, is associated with improved linkage to care, retention, and virologic suppression in controlled studies. We aimed to describe UTT uptake and effect on twelve-month non-retention and initial virologic non-suppression (VnS) among HIV infected adults starting cART in routine HIV program in Kenya. Individual-level HIV service delivery data from 38 health facilities, each representing 38 of the 47 counties in Kenya were analysed. Adults (>15 years) initiating cART between the second-half of 2015 (2015HY2) and the first-half of 2018 (2018HY1) were followed up for twelve months. UTT was defined based on time from an HIV diagnosis to cART initiation and was categorized as same-day, 1-14 days, 15-90 days, and 91+ days. Non-retention was defined as individuals lost-to-follow-up or reported dead by the end of the follow up period. Initial VnS was defined based on the first available viral load test with >400 copies/ml. Hierarchical mixed-effects survival and generalised linear regression models were used to assess the effect of UTT on non-retention and VnS, respectively. Of 8592 individuals analysed, majority (n = 5864 [68.2%]) were female. Same-day HIV diagnosis and cART initiation increased from 15.3% (2015HY2) to 52.2% (2018HY1). The overall non-retention rate was 2.8 (95% CI: 2.6-2.9) per 100 person-months. When compared to individuals initiated cART 91+ days after a HIV diagnosis, those initiated cART on the same day of a HIV diagnosis had the highest rate of non-retention (same-day vs. 91+ days; aHR, 1.7 [95% CI: 1.5-2.0], p<0.001). Of those included in the analysis, 5986 (69.6%) had a first viral load test done at a median of 6.3 (IQR, 5.6-7.6) months after cART initiation. Of these, 835 (13.9%) had VnS. There was no association between UTT and VnS (same-day vs. 91+ days; aRR, 1.0 [95% CI: 0.9-1.2], p = 0.664). Our findings demonstrate substantial uptake of the UTT policy but poor twelve-month retention and lack of an association with initial VnS from routine HIV settings in Kenya. These findings warrant consideration for multi-pronged program interventions alongside UTT policy for maximum intended benefits in Kenya. |
| first_indexed | 2024-04-11T00:28:45Z |
| format | Article |
| id | doaj.art-b6048ceabeb6404a94d32596901e06db |
| institution | Directory Open Access Journal |
| issn | 1932-6203 |
| language | English |
| last_indexed | 2024-04-11T00:28:45Z |
| publishDate | 2022-01-01 |
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| series | PLoS ONE |
| spelling | doaj.art-b6048ceabeb6404a94d32596901e06db2023-01-08T05:31:32ZengPublic Library of Science (PLoS)PLoS ONE1932-62032022-01-011711e027767510.1371/journal.pone.0277675Uptake and effect of universal test-and-treat on twelve months retention and initial virologic suppression in routine HIV program in Kenya.Davies O KimangaViolet A OramisiAmin S HassanMary K MugambiFrederick O MirukaKennedy J MuthokaJacob O OdhiamboPeter K YegonGonza O OmoroCatherine MbaireKenneth M MasamaroSusan M NjogoJoseph L BarkerCatherine N NgugiEarly combination antiretroviral therapy (cART), as recommended in WHO's universal test-and-treat (UTT) policy, is associated with improved linkage to care, retention, and virologic suppression in controlled studies. We aimed to describe UTT uptake and effect on twelve-month non-retention and initial virologic non-suppression (VnS) among HIV infected adults starting cART in routine HIV program in Kenya. Individual-level HIV service delivery data from 38 health facilities, each representing 38 of the 47 counties in Kenya were analysed. Adults (>15 years) initiating cART between the second-half of 2015 (2015HY2) and the first-half of 2018 (2018HY1) were followed up for twelve months. UTT was defined based on time from an HIV diagnosis to cART initiation and was categorized as same-day, 1-14 days, 15-90 days, and 91+ days. Non-retention was defined as individuals lost-to-follow-up or reported dead by the end of the follow up period. Initial VnS was defined based on the first available viral load test with >400 copies/ml. Hierarchical mixed-effects survival and generalised linear regression models were used to assess the effect of UTT on non-retention and VnS, respectively. Of 8592 individuals analysed, majority (n = 5864 [68.2%]) were female. Same-day HIV diagnosis and cART initiation increased from 15.3% (2015HY2) to 52.2% (2018HY1). The overall non-retention rate was 2.8 (95% CI: 2.6-2.9) per 100 person-months. When compared to individuals initiated cART 91+ days after a HIV diagnosis, those initiated cART on the same day of a HIV diagnosis had the highest rate of non-retention (same-day vs. 91+ days; aHR, 1.7 [95% CI: 1.5-2.0], p<0.001). Of those included in the analysis, 5986 (69.6%) had a first viral load test done at a median of 6.3 (IQR, 5.6-7.6) months after cART initiation. Of these, 835 (13.9%) had VnS. There was no association between UTT and VnS (same-day vs. 91+ days; aRR, 1.0 [95% CI: 0.9-1.2], p = 0.664). Our findings demonstrate substantial uptake of the UTT policy but poor twelve-month retention and lack of an association with initial VnS from routine HIV settings in Kenya. These findings warrant consideration for multi-pronged program interventions alongside UTT policy for maximum intended benefits in Kenya.https://doi.org/10.1371/journal.pone.0277675 |
| spellingShingle | Davies O Kimanga Violet A Oramisi Amin S Hassan Mary K Mugambi Frederick O Miruka Kennedy J Muthoka Jacob O Odhiambo Peter K Yegon Gonza O Omoro Catherine Mbaire Kenneth M Masamaro Susan M Njogo Joseph L Barker Catherine N Ngugi Uptake and effect of universal test-and-treat on twelve months retention and initial virologic suppression in routine HIV program in Kenya. PLoS ONE |
| title | Uptake and effect of universal test-and-treat on twelve months retention and initial virologic suppression in routine HIV program in Kenya. |
| title_full | Uptake and effect of universal test-and-treat on twelve months retention and initial virologic suppression in routine HIV program in Kenya. |
| title_fullStr | Uptake and effect of universal test-and-treat on twelve months retention and initial virologic suppression in routine HIV program in Kenya. |
| title_full_unstemmed | Uptake and effect of universal test-and-treat on twelve months retention and initial virologic suppression in routine HIV program in Kenya. |
| title_short | Uptake and effect of universal test-and-treat on twelve months retention and initial virologic suppression in routine HIV program in Kenya. |
| title_sort | uptake and effect of universal test and treat on twelve months retention and initial virologic suppression in routine hiv program in kenya |
| url | https://doi.org/10.1371/journal.pone.0277675 |
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