Page 304 - HIVMED_v21_i1.indb

Page 4 of 6 Original Research

Retention in care by timing of antiretroviral between the timing of ART initiation and viral suppression
therapy initiation or retention in care. Furthermore, we identified that same-
day ART achieves similar retention in care and viral
A total of 477 patients (67.2% of patients who initiated ART)
met our definition of retention in care at 6 months. There suppression when compared with later initiation. These
findings suggest that provision of SDI does not adversely
was no association between retention in care and time of impact long-term care outcomes. It is plausible that the
ART initiation; 69.2% (153) of those who initiated same-day overall retention and viral load suppression is a superior
ART were retained at 6 months compared with 66.1% strategy to delayed ART initiation, because of less time lost
(286) who initiated ART between 1 and 30 days post-diagnosis from care, by reducing the time between the testing visit and
(p = 0.47; Table 3). In a model-adjusted for sex, age and subsequent clinic visit. These are important and encouraging
CD4 count, time of ART initiation did not significantly impact early findings from the routine implementation of SDI that
the relative likelihood retention in care at 6 months (Table 4). help to expand the understanding of the use of SDI beyond
clinical trial settings.
Viral load suppression by timing of antiretroviral
therapy initiation TABLE 4: Log-binomial logistic regression adjusted for age, gender, CD4 count
and antiretroviral therapy initiation group.
A total of 455 patients (64.1% of patients who initiated ART) Characteristic Viral suppression Retention in care
had a 6-month viral load result documented, of which at 6 months at 6 months
359 (79%) were virally suppressed (viral load < 400 c/mL; Risk ratio p-value Risk ratio p-value
Table 3). There was no significant association between n 95% CI n 95% CI
Age (years)
viral suppression and time to ART initiation; 78.1% (118) < 29 Ref - - Ref - -
of patients who initiated same-day ART were virally
30–39 0.93 0.49–1.78 0.84 1.19 0.78–1.82 0.41
suppressed compared with 80.3% (216) patients who ≥ 40 1.64 0.74–3.61 0.22 1.50 0.90–2.48 0.12
initiated ART between 1 and 30 days post-diagnosis (p = 0.5; Sex
Table 4). In a model adjusted for sex, age group and Male Ref - - Ref - -
CD4 count, time of ART initiation did not significantly Female 1.46 0.80–2.64 0.21 0.93 0.63–1.40 0.75
impact the relative likelihood of viral suppression (Table 4). CD4 count
< 200 Ref - - Ref - -
Discussion 201–500 1.58 0.85–2.92 0.15 0.82 0.53–1.25 0.35
0.84
0.88–4.06
0.10
1.05
0.63–1.77
≥ 501
1.90
We found that just over a quarter of patients at 10 Time to ART initiation
Ref
-
-
-
-
Ref
routine care facilities in South Africa initiated same-day ART. Same-day 1.92 0.77–4.90 0.16 0.93 0.51–1.71 0.82
1–7 days
Of those initiating ART, 58% were retained in care at the 8–30 days 1.34 0.67–2.65 0.41 0.73 0.45–1.17 0.19
same clinic at 6 months, and 58% of those retained in care 31–90 days 1.04 0.37–2.96 0.93 0.79 0.38–1.64 0.52
at 6 months had a viral load of < 400 c/mL (80% of those with > 90 days 0.26 0.03–2.17 0.21 1.44 0.15–13.56 0.75
viral load test results). There was no significant association ART, antiretroviral therapy.
TABLE 3: Viral suppression and retention in care at 6 months for those who are on antiretroviral therapy.
Characteristic Viral suppression (< 400) at 6 months Retained in care at 6 months
(n = 455) (n = 710)
Suppressed Not suppressed p-value Retained Not retained p-value
(Chi-squared) (Chi-squared)
n % n % n % n %
Age (years)
< 29 131 80.0 33 20.1 0.31 171 65.8 89 34.2 0.36
30–39 136 75.6 44 24.4 189 65.8 98 34.2 -
≥ 40 92 82.9 19 17.1 117 71.8 46 28.2 -
Sex
Male 123 77.4 36 22.6 0.55 169 68.4 78 31.6 0.61
Female 236 79.7 60 20.3 308 66.5 155 33.5 -
CD4 count
< 200 93 75.0 31 25.0 0.16 128 70.3 54 29.7 0.45
201–500 124 81.6 28 18.4 168 64.6 92 35.4 -
≥ 501 74 85.1 13 14.9 93 70.4 39 29.6 -
No value 68 73.9 24 26.1 88 64.7 48 35.3 -
Time to ART
Same-day 118 78.1 33 21.8 0.50 153 69.2 68 30.8 0.47
1–7 days 56 83.6 11 16.4 76 72.4 29 27.6 -
8–30 days 160 79.2 42 20.8 210 64.0 118 36.0 -
31–90 days 23 74.2 8 25.8 34 66.7 17 33.3 -
> 90 days 2 50.0 2 50.0 4 80.0 1 20.0 -
ART, antiretroviral therapy.

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