Trends in CD4 Count Testing, Retention in Pre-ART Care, and ART Initiation Rates over the First Decade of Expansion of HIV Services in Haiti
BACKGROUND:
High
attrition during the period from HIV testing to antiretroviral therapy (ART)
initiation is widely reported. Though treatment guidelines have changed to
broaden ART eligibility and services have been widely expanded over the past
decade, data on the temporal trends in pre-ART outcomes are limited; such data
would be useful to guide future policy decisions.
METHODS:
We
evaluated temporal trends and predictors of retention for each step from HIV
testing to ART initiation over the past decade at the GHESKIO clinic in
Port-au-Prince Haiti. The 24,925 patients >17 years of age who received a
positive HIV test at GHESKIO from March 1, 2003 to February 28, 2013 were
included. Patients were followed until they remained in pre-ART care for one
year or initiated ART.
RESULTS:
24,925
patients (61% female, median age 35 years) were included, and 15,008 (60%) had
blood drawn for CD4 count within 12 months of HIV testing; the trend increased
over time from 36% in Year 1 to 78% in Year 10 (p<0.0001). Excluding
transfers, the proportion of patients who were retained in pre-ART care or
initiated ART within the first year after HIV testing was 84%, 82%, 64%, and
64%, for CD4 count strata ≤200, 201 to 350, 351 to 500, and >500 cells/mm3,
respectively. The trend increased over time for each CD4 strata, and in Year
10, 94%, 95%, 79%, and 74% were retained in pre-ART care or initiated ART for
each CD4 strata. Predictors of pre-ART attrition included male gender, low
income, and low educational status. Older age and tuberculosis (TB) at HIV
testing were associated with retention in care.
CONCLUSIONS:
The
proportion of patients completing assessments for ART eligibility, remaining in
pre-ART care, and initiating ART have increased over the last decade across all
CD4 count strata, particularly among patients with CD4 count ≤350 cells/mm3.
However, additional retention efforts are needed for patients with higher CD4
counts.
Below: A: Proportion of Patients with Timely, Late, or No Blood Draw for CD4 Count by Year; B: Number and Proportion of Patients Returning for CD4 Count Results by Year
By: Koenig SP1,2, Bernard D1, Dévieux JG3, Atwood S2, McNairy ML4, Severe P1, Marcelin A1, Julma P1, Apollon A1, Pape JW1,4.
- 1Haitian Study Group for Kaposi's Sarcoma and Opportunistic Infections (GHESKIO), Port-au-Prince, Haiti.
- 2Division of Global Health Equity, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, United States of America.
- 3AIDS Prevention Program, Florida International University, Miami, FL, United States of America.
- 4Center for Global Health, Weill Cornell Medical College, New York, NY, United States of America
- PLoS One. 2016 Feb 22;11(2):e0146903. doi: 10.1371/journal.pone.0146903. eCollection 2016.
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