Implementation of “Treat‐all” at adult HIV care and treatment sites in the Global Ie DEA Consortium: results from the Site Assessment Survey

Year: 2019

Type: article

Abstract: INTRODUCTION: Since 2015, the World Health Organization (WHO) has recommended that all people living with HIV (PLHIV) initiate antiretroviral treatment (ART), irrespective of CD4+ count or clinical stage. National adoption of universal treatment has accelerated since WHO's 2015 "Treat All" recommendation; however, little is known about the translation of this guidance into practice. This study aimed to assess the status of Treat All implementation across regions, countries, and levels of the health care delivery system. METHODS: Between June and December 2017, 201/221 (91%) adult HIV treatment sites that participate in the global IeDEA research consortium completed a survey on capacity and practices related to HIV care. Located in 41 countries across seven geographic regions, sites provided information on the status and timing of site-level introduction of Treat All, as well as site-level practices related to ART initiation. RESULTS: Almost all sites (93%) reported that they had begun implementing Treat All, and there were no statistically significant differences in site-level Treat All introduction by health facility type, urban/rural location, sector (public/private) or country income level. The median time between national policy adoption and site-level introduction was one month. In countries where Treat All was not yet adopted in national guidelines, 69% of sites reported initiating all patients on ART, regardless of clinical criteria, and these sites had been implementing Treat All for a median period of seven months at the time of the survey. The majority of sites (77%) reported typically initiating patients on ART within 14 days of confirming diagnosis, with 60% to 62% of sites implementing Treat All in East, Southern and West Africa reporting same-day ART initiation for most patients. CONCLUSIONS: By mid- to late-2017, the Treat All strategy was the standard of care at almost all IeDEA sites, including rural, primary-level health facilities in low-resource settings. While further assessments of site-level capacity to provide high-quality HIV care under Treat All and to support sustained viral suppression after ART initiation are needed, the widespread introduction of Treat All at the service delivery level is a critical step towards global targets for ending the HIV epidemic as a public health threat.

Source: Journal of the International AIDS Society

DOI: 10.1002/jia2.25331

Authors: Ellen Brazier, Fernanda Maruri, Stephany N Duda, Olga Tymejczyk, C William Wester, Geoffrey Somi, Jeremy Ross, Aimee Freeman, Morna Cornell, Armel Poda, Beverly S Musick, Fujie Zhang, Keri N Althoff, Catrina Mugglin, April D Kimmel, Marcel Yotebieng, Denis Nash

Institutions: City University of New York, Vanderbilt University, Vanderbilt University Medical Center, Vanderbilt Health, American Foundation for AIDS Research, Johns Hopkins University, University of Cape Town, Nazi Boni University, Indiana University Indianapolis, Indiana University School of Medicine, Capital Medical University, Beijing Ditan Hospital, University of Bern, Institute of Social and Preventive Medicine, Virginia Commonwealth University, The Ohio State University

Language: English

Topic: HIV/AIDS Research and Interventions

Subfield: Infectious Diseases

Field: Medicine

Domain: Health Sciences

SDGs: Good health and well-being, Reduced inequalities

Open Access status: gold

Estimated APC paid: $2,400

Funders: National Institutes of Health, National Institute of Mental Health, National Institute on Drug Abuse, National Cancer Institute, National Institute of Allergy and Infectious Diseases, National Institute of Child Health and Human Development, Eunice Kennedy Shriver National Institute of Child Health and Human Development

OpenAlex ID: W2962484819