CD4+ T-cell count at antiretroviral therapy initiation in the “treat all” era in rural South Africa: an interrupted time series analysis

Yapa, H Manisha, Kim, Hae-Young, Petoumenos, Kathy, Post, Frank A, Jiamsakul, Awachana, De Neve, Jan-Walter, Tanser, Frank, Iwuji, Collins, Baisley, Kathy, Shahmanesh, Maryam, Pillay, Deenan, Siedner, Mark J, Bärnighausen, Till and Bor, Jacob (2021) CD4+ T-cell count at antiretroviral therapy initiation in the “treat all” era in rural South Africa: an interrupted time series analysis. Clinical Infectious Diseases. ISSN 1058-4838

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Abstract

Background
South Africa implemented universal test and treat (UTT) in September 2016 in an effort to encourage earlier initiation of antiretroviral therapy (ART).

Methods
We therefore conducted an interrupted time series (ITS) analysis to assess the impact of UTT on mean CD4 count at ART initiation among adults ≥16 years old attending 17 public sector primary care services in rural South Africa between July 2014 and March 2019.

Results
Among 20,599 individuals (69% women), CD4 counts were available for 74%. Mean CD4 at ART initiation increased from 317.1 cells/μL (95% confidence interval, CI, 308.6 to 325.6)—one to eight months prior to UTT—to 421.0 cells/μL (95% CI 413.0 to 429.0) one to twelve months after UTT, including an immediate increase of 124.2 cells/μL (95% CI 102.2 to 146.1). However, mean CD4 count subsequently fell to 389.5 cells/μL (95% CI 381.8 to 397.1) 13 to 30 months after UTT, but remained above pre-UTT levels. Men initiated ART at lower CD4 counts than women (-118.2 cells/μL, 95% CI -125.5 to -111.0) throughout the study.

Conclusions
Although UTT led to an immediate increase in CD4 count at ART initiation in this rural community, the long-term effects were modest. More efforts are needed to increase initiation of ART early in HIV infection, particularly among men.

Item Type: Article
Schools and Departments: Brighton and Sussex Medical School > Global Health and Infection
SWORD Depositor: Mx Elements Account
Depositing User: Mx Elements Account
Date Deposited: 10 Aug 2021 15:35
Last Modified: 10 Aug 2021 15:45
URI: http://sro.sussex.ac.uk/id/eprint/101053

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