Original Research

Feasibility of implementing same-day antiretroviral therapy initiation during routine care in Ekurhuleni District, South Africa: Retention and viral load suppression

Nolundi Mshweshwe-Pakela, Bhakti Hansoti, Tonderai Mabuto, Deanna Kerrigan, Griffiths Kubeka, Elizabeth Hahn, Salome Charalambous, Christopher J. Hoffmann
Southern African Journal of HIV Medicine | Vol 21, No 1 | a1085 | DOI: https://doi.org/10.4102/sajhivmed.v21i1.1085 | © 2020 Nolundi Mshweshwe-Pakela, Bhakti Hansoti, Tonderai Mabuto, Deanna Kerrigan, Griffiths Kubeka, Elizabeth Hahn, Salome Charalambous, Christopher J. Hoffmann | This work is licensed under CC Attribution 4.0
Submitted: 10 March 2020 | Published: 20 August 2020

About the author(s)

Nolundi Mshweshwe-Pakela, Implementation Research Division, The Aurum Institute, Johannesburg, South Africa
Bhakti Hansoti, Department 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 America
Tonderai Mabuto, Implementation Research Division, The Aurum Institute, Johannesburg, South Africa; and, School of Public Health, University of the Witwatersrand, Johannesburg, South Africa
Deanna Kerrigan, Department of Sociology, American University, Washington, United States of America
Griffiths Kubeka, Implementation Research Division, The Aurum Institute, Johannesburg, South Africa
Elizabeth Hahn, Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, United States of America
Salome Charalambous, Implementation Research Division, The Aurum Institute, Johannesburg, South Africa; and, School of Public Health, University of the Witwatersrand, Johannesburg, South Africa
Christopher J. Hoffmann, Implementation 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 America


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Abstract

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.


Keywords

HIV testing; primary care; SDI; ARV initiation; implementation

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