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Clinical outcomes after extended 12‐month antiretroviral therapy prescriptions in a community‐based differentiated HIV service delivery programme in South Africa: a retrospective cohort study

INTRODUCTION: There is an urgent need for more efficient models of differentiated antiretroviral therapy (ART) delivery for people living with HIV (PLHIV), with the World Health Organization calling for evidence to guide whether annual ART prescriptions and consultations (12M scripts) should be reco...

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Autores principales: Lewis, Lara, Sookrajh, Yukteshwar, van der Molen, Johan, Khubone, Thokozani, Sosibo, Phelelani, Maraj, Munthra, van Heerden, Rose, Little, Francesca, Kassanjee, Reshma, Garrett, Nigel, Dorward, Jienchi
Formato: Online Artículo Texto
Lenguaje:English
Publicado: John Wiley and Sons Inc. 2023
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10535055/
https://www.ncbi.nlm.nih.gov/pubmed/37767825
http://dx.doi.org/10.1002/jia2.26164
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author Lewis, Lara
Sookrajh, Yukteshwar
van der Molen, Johan
Khubone, Thokozani
Sosibo, Phelelani
Maraj, Munthra
van Heerden, Rose
Little, Francesca
Kassanjee, Reshma
Garrett, Nigel
Dorward, Jienchi
author_facet Lewis, Lara
Sookrajh, Yukteshwar
van der Molen, Johan
Khubone, Thokozani
Sosibo, Phelelani
Maraj, Munthra
van Heerden, Rose
Little, Francesca
Kassanjee, Reshma
Garrett, Nigel
Dorward, Jienchi
author_sort Lewis, Lara
collection PubMed
description INTRODUCTION: There is an urgent need for more efficient models of differentiated antiretroviral therapy (ART) delivery for people living with HIV (PLHIV), with the World Health Organization calling for evidence to guide whether annual ART prescriptions and consultations (12M scripts) should be recommended in global guidelines. We assessed the association between 12M scripts (allowed temporarily during the COVID‐19 pandemic) versus standard 6‐month prescriptions and consultations (6M scripts) and clinical outcomes. METHODS: We performed a retrospective cohort study using routine, de‐identified data from 59 public clinics in KwaZulu‐Natal, South Africa. We included PLHIV aged ≥18 years with a recent suppressed viral load (VL) who had been referred for community ART delivery with 6M or 12M scripts. We used modified Poisson regression to compare 12‐month retention‐in‐care (≤90 days late for all visits) and viral suppression (<50 copies/ml) between prescription groups. RESULTS: Among 27,148 PLHIV referred for community ART during Jun–Dec 2020, 57.4% received 12M scripts. The median age was 39 years and 69.4% were women. Age, sex, prior community ART use and time on ART were similar across groups. However, more of the 12M script group had dolutegravir‐based regimens (60.0% vs. 46.3%). The median (interquartile range) number of clinic visits in the year of follow‐up was 1(1‐1) in the 12M group and 2(2‐3) in the 6M group. Retention was 94.6% (95% confidence interval [CI]: 94.2%–94.9%) among those receiving 12M scripts and 91.8% (95% CI: 91.3%–92.3%) among those with 6M scripts. 17.1% and 16.9% of clients in the 12M and 6M groups were missing follow‐up VL data, respectively. Among those with VLs, 92.4% (95% CI: 92.0%–92.9%) in the 12M group and 91.4% (95% CI: 90.8%–92.0%) in the 6M group were suppressed. After adjusting for age, sex, ART regimen, time on ART, prior community ART use and calendar month, retention (adjusted risk ratio [aRR]: 1.03, 95% CI: 1.01–1.05) and suppression (aRR: 1.00, 95% CI: 0.99–1.01) were similar across groups. CONCLUSIONS: Among PLHIV referred for community ART with a recent suppressed VL, the use of 12M scripts reduced clinic visits without impacting short‐term clinical outcomes. 12M scripts should be considered for differentiated service delivery programmes.
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spelling pubmed-105350552023-09-29 Clinical outcomes after extended 12‐month antiretroviral therapy prescriptions in a community‐based differentiated HIV service delivery programme in South Africa: a retrospective cohort study Lewis, Lara Sookrajh, Yukteshwar van der Molen, Johan Khubone, Thokozani Sosibo, Phelelani Maraj, Munthra van Heerden, Rose Little, Francesca Kassanjee, Reshma Garrett, Nigel Dorward, Jienchi J Int AIDS Soc Research Articles INTRODUCTION: There is an urgent need for more efficient models of differentiated antiretroviral therapy (ART) delivery for people living with HIV (PLHIV), with the World Health Organization calling for evidence to guide whether annual ART prescriptions and consultations (12M scripts) should be recommended in global guidelines. We assessed the association between 12M scripts (allowed temporarily during the COVID‐19 pandemic) versus standard 6‐month prescriptions and consultations (6M scripts) and clinical outcomes. METHODS: We performed a retrospective cohort study using routine, de‐identified data from 59 public clinics in KwaZulu‐Natal, South Africa. We included PLHIV aged ≥18 years with a recent suppressed viral load (VL) who had been referred for community ART delivery with 6M or 12M scripts. We used modified Poisson regression to compare 12‐month retention‐in‐care (≤90 days late for all visits) and viral suppression (<50 copies/ml) between prescription groups. RESULTS: Among 27,148 PLHIV referred for community ART during Jun–Dec 2020, 57.4% received 12M scripts. The median age was 39 years and 69.4% were women. Age, sex, prior community ART use and time on ART were similar across groups. However, more of the 12M script group had dolutegravir‐based regimens (60.0% vs. 46.3%). The median (interquartile range) number of clinic visits in the year of follow‐up was 1(1‐1) in the 12M group and 2(2‐3) in the 6M group. Retention was 94.6% (95% confidence interval [CI]: 94.2%–94.9%) among those receiving 12M scripts and 91.8% (95% CI: 91.3%–92.3%) among those with 6M scripts. 17.1% and 16.9% of clients in the 12M and 6M groups were missing follow‐up VL data, respectively. Among those with VLs, 92.4% (95% CI: 92.0%–92.9%) in the 12M group and 91.4% (95% CI: 90.8%–92.0%) in the 6M group were suppressed. After adjusting for age, sex, ART regimen, time on ART, prior community ART use and calendar month, retention (adjusted risk ratio [aRR]: 1.03, 95% CI: 1.01–1.05) and suppression (aRR: 1.00, 95% CI: 0.99–1.01) were similar across groups. CONCLUSIONS: Among PLHIV referred for community ART with a recent suppressed VL, the use of 12M scripts reduced clinic visits without impacting short‐term clinical outcomes. 12M scripts should be considered for differentiated service delivery programmes. John Wiley and Sons Inc. 2023-09-28 /pmc/articles/PMC10535055/ /pubmed/37767825 http://dx.doi.org/10.1002/jia2.26164 Text en © 2023 The Authors. Journal of the International AIDS Society published by John Wiley & Sons Ltd on behalf of International AIDS Society. https://creativecommons.org/licenses/by/4.0/This is an open access article under the terms of the http://creativecommons.org/licenses/by/4.0/ (https://creativecommons.org/licenses/by/4.0/) License, which permits use, distribution and reproduction in any medium, provided the original work is properly cited.
spellingShingle Research Articles
Lewis, Lara
Sookrajh, Yukteshwar
van der Molen, Johan
Khubone, Thokozani
Sosibo, Phelelani
Maraj, Munthra
van Heerden, Rose
Little, Francesca
Kassanjee, Reshma
Garrett, Nigel
Dorward, Jienchi
Clinical outcomes after extended 12‐month antiretroviral therapy prescriptions in a community‐based differentiated HIV service delivery programme in South Africa: a retrospective cohort study
title Clinical outcomes after extended 12‐month antiretroviral therapy prescriptions in a community‐based differentiated HIV service delivery programme in South Africa: a retrospective cohort study
title_full Clinical outcomes after extended 12‐month antiretroviral therapy prescriptions in a community‐based differentiated HIV service delivery programme in South Africa: a retrospective cohort study
title_fullStr Clinical outcomes after extended 12‐month antiretroviral therapy prescriptions in a community‐based differentiated HIV service delivery programme in South Africa: a retrospective cohort study
title_full_unstemmed Clinical outcomes after extended 12‐month antiretroviral therapy prescriptions in a community‐based differentiated HIV service delivery programme in South Africa: a retrospective cohort study
title_short Clinical outcomes after extended 12‐month antiretroviral therapy prescriptions in a community‐based differentiated HIV service delivery programme in South Africa: a retrospective cohort study
title_sort clinical outcomes after extended 12‐month antiretroviral therapy prescriptions in a community‐based differentiated hiv service delivery programme in south africa: a retrospective cohort study
topic Research Articles
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10535055/
https://www.ncbi.nlm.nih.gov/pubmed/37767825
http://dx.doi.org/10.1002/jia2.26164
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