Understanding the effects of universal test and treat on longitudinal HIV care outcomes among South African youth: a retrospective cohort study
Year: 2023
Type: article
Study design: Observational Study
Abstract: INTRODUCTION: Little is known about the effects of universal test and treat (UTT) policies on HIV care outcomes among youth living with HIV (YLHIV). Moreover, there is a paucity of information regarding when YLHIV are most susceptible to disengagement from care under the newest treatment guidelines. The longitudinal HIV care continuum is an underutilized tool that can provide a holistic understanding of population-level HIV care trajectories and be used to compare treatment outcomes across groups. We aimed to explore effects of the UTT policy on longitudinal outcomes among South African YLHIV and identify temporally precise opportunities for re-engaging this priority population in the UTT era. METHODS: Using medical record data, we conducted a retrospective cohort study among youth aged 18-24 diagnosed with HIV from August 2015-December 2018 in nine health care facilities in South Africa. We used Fine and Gray sub-distribution proportional hazards models to characterize longitudinal care continuum outcomes in the population overall and stratified by treatment era of diagnosis. We estimated the proportion of individuals in each stage of the continuum over time and the restricted mean time spent in each stage in the first year following diagnosis. Sub-group estimates were compared using differences. RESULTS: A total of 420 YLHIV were included. By day 365 following diagnosis, just 23% of individuals had no 90-or-more-day lapse in care and were virally suppressed. Those diagnosed in the UTT era spent less time as ART-naïve (mean difference=-19.3 days; 95% CI: -27.7, -10.9) and more time virally suppressed (mean difference = 17.7; 95% CI: 1.0, 34.4) compared to those diagnosed pre-UTT. Most individuals who were diagnosed in the UTT era and experienced a 90-or-more-day lapse in care disengaged between diagnosis and linkage to care or ART initiation and viral suppression. CONCLUSIONS: Implementation of UTT yielded modest improvements in time spent on ART and virally suppressed among South African YLHIV- however, meeting UNAIDS' 95-95-95 targets remains a challenge. Retention in care and re-engagement interventions that can be implemented between diagnosis and linkage to care and between ART initiation and viral suppression (e.g., longitudinal counseling) may be particularly important to improving care outcomes among South African YLHIV in the UTT era.
Source: BMC Public Health
Institutions: Washington University in St. Louis, University of North Carolina at Chapel Hill, University of the Witwatersrand, Agincourt Health and Socio-Demographic Surveillance System, Population Council, Population Council, Florida State University, University of California System, University of California, Berkeley
Language: English
Subfield: Infectious Diseases
Field: Medicine
Domain: Health Sciences
Open Access status: gold
Estimated APC paid: $2,990
Funders: United States Agency for International Development, ViiV Healthcare, Department of Science and Innovation, South Africa, South African Medical Research Council, National Institutes of Health, National Institute of Mental Health, National Institute of Allergy and Infectious Diseases, Fogarty International Center, National Institute of Neurological Disorders and Stroke, National Institute on Minority Health and Health Disparities, Eunice Kennedy Shriver National Institute of Child Health and Human Development
Awards: G1271669171, Training LEADers to Accelerate Global Mental Health Disparities in Research (LEAD), G2776065089, Comparative effectiveness of tailored HIV treatment plans and mortality, G7111768909, Carolina Population Center, Center for AIDS Prevention Studies (CAPS), UJMT LAUNCH: Training the next generation of leaders in global health research
OpenAlex ID: W4386458141