The aim of this study was to determine the effects of the same day ART initiation on viral suppression; and identify predicators of viral suppression in the era of test and treat strategy.
A quantitative multicenter retrospective cohort study was conducted using routinely collected data in ART clinics during the initial and follow-up visits of clients in 18 public health facilities in Addis Ababa, Ethiopia. The same day initiation of antiretroviral treatment among PLHIV with age greater or equal to 15, regardless of their CD4 count can reduce morbidity, mortality, HIV transmission and eventually the incidence of new HIV infection. However, the effect of the same day ART
initiation on viral suppression remains contradicting.
The viral load suppression rate among the same day ART started was higher compared to those started ART after seven days, and is consistent with previous studies in other countries. TDF- based regimen, alive and on ART follow-up status, and working
functional status were predicators of viral suppression in this study. Strengthening the same day ART initiation with TDF based regimen is critical for prevention of HIV through viral suppression. Improving the quality of ART data is also essential to generate evidence and inform the practice.
Table of Contents
Introduction
Research Objectives
Methods
Result
Discussion
Conclusion
Recommendations
References
Research Objectives and Themes
The primary aim of this research is to evaluate the impact of same-day antiretroviral treatment (ART) initiation on viral load suppression rates among adults living with HIV in Addis Ababa, Ethiopia, and to identify the key factors associated with successful viral suppression within the current "test and treat" strategy framework.
- Comparison of viral suppression rates between same-day ART initiation and delayed initiation (after 7 days).
- Identification of sociodemographic and clinical predictors of viral suppression.
- Evaluation of treatment outcomes in the era of the "test and treat" strategy.
- Assessment of data quality and completeness in electronic medical record (EMR-ART) systems across public health facilities.
- Investigation of the efficacy of different ART regimens on viral load outcomes.
Excerpt from the Thesis
Methods
Study Setting: Addis Ababa is an administrative and economic capital of Ethiopia, and home for an estimated population of 5.2 million. It has 11 sub-cities and more than 115 functional public health facilities (13 public hospitals and 102 health centers) that provide healthcare services for the public. The aggregate data from district health information system (DHIS2) showed that there are 78 Health centers and 11 public hospitals which are providing ART services. These ART sites compile and sent monthly report to the Addis Ababa Regional Health bureau on a regular base. Including the public health facilities, 114 ART sites use an Enhanced Electronic Medical Record- ART database system (EMR-ART system) developed by ICAP (International Center for AIDS care and treatment Program)- Ethiopia, to collect and manage individual level ART data(29). The study collected the database backup data from 18 public health facilities in Addis Ababa. The list of public facility sites from where the database backup file collected were eight public hospitals: Zewditu Memorial, ALERT, Black Lion, St.Paul, St. Peter, Yekatit-12, Ras Desta Memorial and Gandhi Memorial hospital, and ten public health centers: Efoita, Feres, Hiwotamba, JagemaKelo, Keraneyo, Kirkose, kolfe, Lideta, Mikilayland, and Kolfe Woreda 9 health center. All clients receive ART services in these public facilities free of charge.
Study design: We conducted a multicenter retrospective cohort analysis of the effect of the same day ART initiation on virological outcome among adults ≥15yrs of age PLHIV who started ART from 2017 to 2021 in Addis Ababa. We took individuals who started ART within five years of duration as sample size wouldn’t be enough when the exclusion criteria applied. The study used secondary extracted from enhanced standalone EMR- ART database backup files from 18 public health facilities, and merged to a single database.
Summary of Chapters
Introduction: Provides the global and Ethiopian context of HIV/AIDS, emphasizing the importance of the rapid ART initiation strategy for achieving viral suppression.
Research Objectives: Outlines the main and specific objectives focused on determining the effects of same-day ART initiation on viral load suppression and identifying associated factors.
Methods: Describes the multicenter retrospective cohort study design, data extraction from EMR-ART databases, and the statistical analysis techniques used.
Result: Presents the findings regarding participant characteristics and shows that same-day ART initiation leads to higher viral suppression rates compared to late initiation.
Discussion: Interprets the findings by comparing them with existing randomized trials and studies in similar settings, highlighting the impact of ART regimens on outcomes.
Conclusion: Synthesizes the evidence that same-day ART initiation and TDF-based regimens are critical for improved viral suppression in the test and treat era.
Recommendations: Suggests strengthening the implementation of same-day ART initiation and calls for improved data quality and completeness in medical record systems.
References: Lists the academic and clinical sources and guidelines supporting the research.
Keywords
HIV/AIDS, Antiretroviral Treatment, Viral Load Suppression, Rapid ART Initiation, Test and Treat, Ethiopia, Public Health, Tenofovir, EMR-ART, Treatment Adherence, Retrospective Cohort, Clinical Outcomes.
Frequently Asked Questions
What is the core focus of this research?
The study investigates the impact of initiating antiretroviral treatment on the same day as an HIV diagnosis compared to starting treatment after seven days, specifically in relation to viral load suppression at 12 months.
What are the primary thematic areas?
The main themes include HIV continuum of care, the effectiveness of the rapid ART initiation (test and treat) policy, and factors influencing viral load suppression among adults.
What is the primary objective of this study?
To determine if same-day ART initiation increases viral suppression rates at the 12-month mark and to identify independent predictors of viral suppression.
Which scientific methodology was employed?
The researchers conducted a multicenter retrospective cohort study, utilizing secondary data extracted from enhanced EMR-ART databases across 18 public health facilities in Addis Ababa.
What aspects are covered in the main section of the paper?
The paper covers the study setting, research design, sample selection, data collection procedures, statistical analysis, demographic and clinical baseline characteristics, and discussions regarding the statistical significance of treatment outcomes.
Which keywords best characterize this work?
Key terms include HIV/AIDS, Antiretroviral Treatment (ART), Viral Load Suppression, Rapid ART Initiation, and Test and Treat strategy.
Did the study find a significant difference in viral suppression between the two groups?
Yes, the study found that individuals who started ART on the same day of diagnosis had a statistically significantly higher rate of viral suppression at 12 months compared to those who started after seven days.
What role does the Tenofovir (TDF) regimen play in viral suppression?
The study identified TDF-based regimens as a significant predictor of viral suppression, showing better efficacy for patients compared to other treatment options.
What were the main constraints regarding data quality?
The researchers reported high volumes of missing data for variables such as CD4 count, WHO clinical stage, and educational level, which posed challenges for the multivariable analysis.
What are the implications for policy makers?
The findings support the strengthening of the "test and treat" strategy and highlight the urgent need for better data management and completeness in public health electronic records to support evidence-based decision-making.
- Citar trabajo
- Girma Birru (Autor), 2023, Effects of Same-Day ART initiation on Treatment Outcomes, Múnich, GRIN Verlag, https://www.grin.com/document/1478159
