Page 301 - HIVMED_v21_i1.indb

Southern African Journal of HIV Medicine
ISSN: (Online) 2078-6751, (Print) 1608-9693
Page 1 of 6 Original Research

Feasibility of implementing same-day

antiretroviral therapy initiation during routine

care in Ekurhuleni District, South Africa:

Retention and viral load suppression

Authors: Background: Same-day initiation (SDI) of antiretroviral therapy (ART) has been advocated as
Nolundi Mshweshwe- an approach to increase linkage to care and overall ART initiation. Clinical trials have
Pakela 1
Bhakti Hansoti demonstrated impressive benefits. However, questions regarding patient preparedness and
2,3
Tonderai Mabuto retention in care remain for routine implementation of this approach.
1,4
Deanna Kerrigan 5
Griffiths Kubeka Objectives: In this study, we sought to describe SDI of ART during routine care delivery and
1
Elizabeth Hahn 3 compare time to ART initiation on longitudinal care outcomes.
Salome Charalambous
1,4
Christopher J. Hoffmann 1,6,7 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.
Affiliations: Records were reviewed for a period of 1 year post-diagnosis. Abstracted data included
1 Implementation Research
Division, The Aurum Institute, demographics, time to ART initiation, clinic visits and laboratory test results (including
Johannesburg, South Africa viral load testing).
2 Department of Emergency Results: A total of 993 patient records were reviewed, of which 826 were included in the
Medicine, Johns Hopkins analysis. The majority of patients (752, 91%) had ART initiation recorded, of which 654 (79%)
School of Medicine, had ART initiated within 30 days, and 224 (27%) had SDI. Uptake of SDI of ART was
Baltimore, United States of higher among women (36% vs. 10.4%; p < 0.001) and in younger patients (33.7% in those
America
< 29 years; p < 0.01). Retention in care at 6 months was achieved in 477 (58%) patients. Of those
3 Department of International with 6-month viral loads, 350/430 (73%) had a viral load < 400 c/m. Retention in care and
Health, Johns Hopkins viral suppression were similar among those with SDI of ART and later ART initiation.
Bloomberg School of Public
Health, Baltimore, Conclusion: Same-day initiation of ART was successfully delivered with similar retention
United States of America and viral load outcomes as subsequent initiation, providing re-assurance for scale-up of this
strategy in routine care.
4 School of Public Health,
University of the Keywords: HIV testing; primary care; SDI; ARV initiation; implementation.
Witwatersrand,
Johannesburg, South Africa
Introduction
5 Department of Sociology,
American University, Timely linkage to antiretroviral therapy (ART) is pivotal to decreasing human
Washington, United States of immunodeficiency virus (HIV) transmission and reducing HIV-associated morbidity and
America
1
mortality. Increasing evidence indicates that same-day initiation (SDI) of ART can increase
6 Department of Medicine, overall linkage to care (LTC) and the proportion of patients with viral load suppression. 2,3,4,5,6,7
Johns Hopkins University Randomised studies from South Africa, Haiti and Lesotho have demonstrated the feasibility,
School of Medicine, acceptability and improved retention over 6 months with SDI of ART when compared with
Baltimore, United States of standard practices in research settings. 5,8,9 In response to clinical trial evidence of the benefits
America
of SDI of ART, the South African Department of Health announced a policy of universal
7 Department of Health, testing and treatment (UTT) in public health facilities in September 2016 and endorsed
10
Behavior, and Society, Johns SDI of ART. The UTT directorate specified: ‘ART should be started as soon as the patient is
Hopkins Bloomberg School ready and within 2 weeks’, with immediate (same-day) initiation prioritised for pregnant
of Public Health, Baltimore, or breastfeeding women. Same-day initiation of ART was further highlighted as a priority
10
United States of America
in a 2017 South African Department of Health circular. 10,11 and in the 2017 World
Health Organization rapid ART initiation guidelines. 12
Read online: Corresponding author: Christopher Hoffmann, [email protected]
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Scan this QR
Scan this QR Dates: Received: 10 Mar. 2020 | Accepted: 07 May 2020 | Published: 20 Aug. 2020
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mobile device therapy initiation during routine care in Ekurhuleni District, South Africa: Retention and viral load suppression. S Afr J HIV Med.
2020;21(1), a1085. https://doi.org/10.4102/sajhivmed.v21i1.1085
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Copyright: © 2020. The Authors. Licensee: AOSIS. This work is licensed under the Creative Commons Attribution License.
http://www.sajhivmed.org.za 293 Open Access