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Uptake and effect of universal test-and-treat on twelve months retention and initial virologic suppression in routine HIV program in Kenya

Early combination antiretroviral therapy (cART), as recommended in WHO’s universal test-and-treat (UTT) policy, is associated with improved linkage to care, retention, and virologic suppression in controlled studies. We aimed to describe UTT uptake and effect on twelve-month non-retention and initia...

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Autores principales: Kimanga, Davies O., Oramisi, Violet A., Hassan, Amin S., Mugambi, Mary K., Miruka, Frederick O., Muthoka, Kennedy J., Odhiambo, Jacob O., Yegon, Peter K., Omoro, Gonza O., Mbaire, Catherine, Masamaro, Kenneth M., Njogo, Susan M., Barker, Joseph L, Ngugi, Catherine N.
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Public Library of Science 2022
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9681077/
https://www.ncbi.nlm.nih.gov/pubmed/36413522
http://dx.doi.org/10.1371/journal.pone.0277675
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author Kimanga, Davies O.
Oramisi, Violet A.
Hassan, Amin S.
Mugambi, Mary K.
Miruka, Frederick O.
Muthoka, Kennedy J.
Odhiambo, Jacob O.
Yegon, Peter K.
Omoro, Gonza O.
Mbaire, Catherine
Masamaro, Kenneth M.
Njogo, Susan M.
Barker, Joseph L
Ngugi, Catherine N.
author_facet Kimanga, Davies O.
Oramisi, Violet A.
Hassan, Amin S.
Mugambi, Mary K.
Miruka, Frederick O.
Muthoka, Kennedy J.
Odhiambo, Jacob O.
Yegon, Peter K.
Omoro, Gonza O.
Mbaire, Catherine
Masamaro, Kenneth M.
Njogo, Susan M.
Barker, Joseph L
Ngugi, Catherine N.
author_sort Kimanga, Davies O.
collection PubMed
description Early combination antiretroviral therapy (cART), as recommended in WHO’s universal test-and-treat (UTT) policy, is associated with improved linkage to care, retention, and virologic suppression in controlled studies. We aimed to describe UTT uptake and effect on twelve-month non-retention and initial virologic non-suppression (VnS) among HIV infected adults starting cART in routine HIV program in Kenya. Individual-level HIV service delivery data from 38 health facilities, each representing 38 of the 47 counties in Kenya were analysed. Adults (>15 years) initiating cART between the second-half of 2015 (2015HY2) and the first-half of 2018 (2018HY1) were followed up for twelve months. UTT was defined based on time from an HIV diagnosis to cART initiation and was categorized as same-day, 1–14 days, 15–90 days, and 91+ days. Non-retention was defined as individuals lost-to-follow-up or reported dead by the end of the follow up period. Initial VnS was defined based on the first available viral load test with >400 copies/ml. Hierarchical mixed-effects survival and generalised linear regression models were used to assess the effect of UTT on non-retention and VnS, respectively. Of 8592 individuals analysed, majority (n = 5864 [68.2%]) were female. Same-day HIV diagnosis and cART initiation increased from 15.3% (2015HY2) to 52.2% (2018HY1). The overall non-retention rate was 2.8 (95% CI: 2.6–2.9) per 100 person-months. When compared to individuals initiated cART 91+ days after a HIV diagnosis, those initiated cART on the same day of a HIV diagnosis had the highest rate of non-retention (same-day vs. 91+ days; aHR, 1.7 [95% CI: 1.5–2.0], p<0.001). Of those included in the analysis, 5986 (69.6%) had a first viral load test done at a median of 6.3 (IQR, 5.6–7.6) months after cART initiation. Of these, 835 (13.9%) had VnS. There was no association between UTT and VnS (same-day vs. 91+ days; aRR, 1.0 [95% CI: 0.9–1.2], p = 0.664). Our findings demonstrate substantial uptake of the UTT policy but poor twelve-month retention and lack of an association with initial VnS from routine HIV settings in Kenya. These findings warrant consideration for multi-pronged program interventions alongside UTT policy for maximum intended benefits in Kenya.
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spelling pubmed-96810772022-11-23 Uptake and effect of universal test-and-treat on twelve months retention and initial virologic suppression in routine HIV program in Kenya Kimanga, Davies O. Oramisi, Violet A. Hassan, Amin S. Mugambi, Mary K. Miruka, Frederick O. Muthoka, Kennedy J. Odhiambo, Jacob O. Yegon, Peter K. Omoro, Gonza O. Mbaire, Catherine Masamaro, Kenneth M. Njogo, Susan M. Barker, Joseph L Ngugi, Catherine N. PLoS One Research Article Early combination antiretroviral therapy (cART), as recommended in WHO’s universal test-and-treat (UTT) policy, is associated with improved linkage to care, retention, and virologic suppression in controlled studies. We aimed to describe UTT uptake and effect on twelve-month non-retention and initial virologic non-suppression (VnS) among HIV infected adults starting cART in routine HIV program in Kenya. Individual-level HIV service delivery data from 38 health facilities, each representing 38 of the 47 counties in Kenya were analysed. Adults (>15 years) initiating cART between the second-half of 2015 (2015HY2) and the first-half of 2018 (2018HY1) were followed up for twelve months. UTT was defined based on time from an HIV diagnosis to cART initiation and was categorized as same-day, 1–14 days, 15–90 days, and 91+ days. Non-retention was defined as individuals lost-to-follow-up or reported dead by the end of the follow up period. Initial VnS was defined based on the first available viral load test with >400 copies/ml. Hierarchical mixed-effects survival and generalised linear regression models were used to assess the effect of UTT on non-retention and VnS, respectively. Of 8592 individuals analysed, majority (n = 5864 [68.2%]) were female. Same-day HIV diagnosis and cART initiation increased from 15.3% (2015HY2) to 52.2% (2018HY1). The overall non-retention rate was 2.8 (95% CI: 2.6–2.9) per 100 person-months. When compared to individuals initiated cART 91+ days after a HIV diagnosis, those initiated cART on the same day of a HIV diagnosis had the highest rate of non-retention (same-day vs. 91+ days; aHR, 1.7 [95% CI: 1.5–2.0], p<0.001). Of those included in the analysis, 5986 (69.6%) had a first viral load test done at a median of 6.3 (IQR, 5.6–7.6) months after cART initiation. Of these, 835 (13.9%) had VnS. There was no association between UTT and VnS (same-day vs. 91+ days; aRR, 1.0 [95% CI: 0.9–1.2], p = 0.664). Our findings demonstrate substantial uptake of the UTT policy but poor twelve-month retention and lack of an association with initial VnS from routine HIV settings in Kenya. These findings warrant consideration for multi-pronged program interventions alongside UTT policy for maximum intended benefits in Kenya. Public Library of Science 2022-11-22 /pmc/articles/PMC9681077/ /pubmed/36413522 http://dx.doi.org/10.1371/journal.pone.0277675 Text en https://creativecommons.org/publicdomain/zero/1.0/This is an open access article, free of all copyright, and may be freely reproduced, distributed, transmitted, modified, built upon, or otherwise used by anyone for any lawful purpose. The work is made available under the Creative Commons CC0 (https://creativecommons.org/publicdomain/zero/1.0/) public domain dedication.
spellingShingle Research Article
Kimanga, Davies O.
Oramisi, Violet A.
Hassan, Amin S.
Mugambi, Mary K.
Miruka, Frederick O.
Muthoka, Kennedy J.
Odhiambo, Jacob O.
Yegon, Peter K.
Omoro, Gonza O.
Mbaire, Catherine
Masamaro, Kenneth M.
Njogo, Susan M.
Barker, Joseph L
Ngugi, Catherine N.
Uptake and effect of universal test-and-treat on twelve months retention and initial virologic suppression in routine HIV program in Kenya
title Uptake and effect of universal test-and-treat on twelve months retention and initial virologic suppression in routine HIV program in Kenya
title_full Uptake and effect of universal test-and-treat on twelve months retention and initial virologic suppression in routine HIV program in Kenya
title_fullStr Uptake and effect of universal test-and-treat on twelve months retention and initial virologic suppression in routine HIV program in Kenya
title_full_unstemmed Uptake and effect of universal test-and-treat on twelve months retention and initial virologic suppression in routine HIV program in Kenya
title_short Uptake and effect of universal test-and-treat on twelve months retention and initial virologic suppression in routine HIV program in Kenya
title_sort uptake and effect of universal test-and-treat on twelve months retention and initial virologic suppression in routine hiv program in kenya
topic Research Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9681077/
https://www.ncbi.nlm.nih.gov/pubmed/36413522
http://dx.doi.org/10.1371/journal.pone.0277675
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