ArticleJournal of acquired immune deficiency syndromes (1999)2013
Mortality associated with delays between clinic entry and ART initiation in resource-limited settings: results of a transition-state model.
Article in Journal of acquired immune deficiency syndromes (1999), 2013. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 21 papers.
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Who cites it
21 citing papers in PubMed.
- Algorithm-guided empirical tuberculosis treatment for people with advanced HIV (TB Fast Track): an open-label, cluster-randomised trial.The lancet. HIV · 2020Trial
- Initiating Antiretroviral Therapy for HIV at a Patient's First Clinic Visit: The RapIT Randomized Controlled Trial.PLoS medicine · 2016Trial
- Trial
- A Risk Prediction Model to Identify People Living with HIV Who are High-risk for Disengagement from Care after HIV Diagnosis in South Africa.AIDS and behavior · 2024Article
- Digitally supported HIV self-testing increases facility-based HIV testing capacity in Ekurhuleni, South Africa.Southern African journal of HIV medicine · 2022Article
- Survival status and predictors of mortality among HIV-positive children initiated antiretroviral therapy in Bahir Dar town public health facilities Amhara region, Ethiopia, 2020.SAGE open medicine · 2022Article
- Same-day antiretroviral therapy initiation hub model at the Thai Red Cross Anonymous Clinic in Bangkok, Thailand: an observational cohort study.Journal of the International AIDS Society · 2021Observational
- HIV testing services in healthcare facilities in South Africa: a missed opportunity.Journal of the International AIDS Society · 2019Article
- Relationship Between Time to Initiation of Antiretroviral Therapy and Treatment Outcomes: A Cohort Analysis of ART Eligible Adolescents in Zimbabwe.Journal of acquired immune deficiency syndromes (1999) · 2017Article
- Risk factors for mortality among malnourished HIV-infected adults eligible for antiretroviral therapy.BMC infectious diseases · 2016Article
- Article
- Article
- Simplified HIV Testing and Treatment in China: Analysis of Mortality Rates Before and After a Structural Intervention.PLoS medicine · 2015Article
- Better adherence to pre-antiretroviral therapy guidelines after implementing an electronic medical record system in rural Kenyan HIV clinics: a multicenter pre-post study.International journal of infectious diseases : IJID : official publication of the International Society for Infectious Diseases · 2015Article
- Outcomes from the implementation of a counselling model supporting rapid antiretroviral treatment initiation in a primary healthcare clinic in Khayelitsha, South Africa.Southern African journal of HIV medicine · 2015Article
- The clock is ticking: the rate and timeliness of antiretroviral therapy initiation from the time of treatment eligibility in Kenya.Journal of the International AIDS Society · 2015Article
- Modeling the implementation of universal coverage for HIV treatment as prevention and its impact on the HIV epidemic.Current HIV/AIDS reports · 2014Review
- Treatment outcomes in a decentralized antiretroviral therapy program: a comparison of two levels of care in north central Nigeria.AIDS research and treatment · 2014Article
- Predictors of delayed antiretroviral therapy initiation, mortality, and loss to followup in HIV infected patients eligible for HIV treatment: data from an HIV cohort study in India.BioMed research international · 2013Article
- Alarming attrition rates among HIV-infected individuals in pre-antiretroviral therapy care in Myanmar, 2011-2014.Global health actionArticle
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Authors and funding
8 authors.
Funding
Abstract
objectiveTo estimate the mortality impact of delay in antiretroviral therapy (ART) initiation from the time of entry into care.
designA state-transition Markov process model. This technique allows for assessing mortality before and after ART initiation associated with delays in ART initiation among a general population of ART-eligible patients without conducting a randomized trial.
methodsWe used patient-level data from 3 South African cohorts to determine transition probabilities for pre-ART CD4 count changes and pre-ART and on-ART mortality. For each parameter, we generated probabilities and distributions for Monte Carlo simulations with 1-week cycles to estimate mortality 52 weeks from clinic entry.
resultsWe estimated an increase in mortality from 11.0% to 14.7% (relative increase of 34%) with a 10-week delay in ART for patients entering care with our pre-ART cohort CD4 distribution. When we examined low CD4 ranges, the relative increase in mortality delays remained similar; however, the absolute increase in mortality rose. For example, among patients entering with CD4 count 50-99 cells per cubic millimeter, 12-month mortality increased from 13.3% with no delay compared with 17.0% with a 10-week delay and 22.9% with a 6-month delay.
conclusionsDelays in ART initiation, common in routine HIV programs, can lead to important increases in mortality. Prompt ART initiation for patients entering clinical care and eligible for ART, especially those with lower CD4 counts, could be a relatively low-cost approach with a potential marked impact on mortality.
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