ArticleAIDS (London, England)2015
Trends in and correlates of CD4+ cell count at antiretroviral therapy initiation after changes in national ART guidelines in Rwanda.
Article in AIDS (London, England), 2015. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 28 papers, 1 of them a synthesis that pooled it.
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Who cites it
28 citing papers in PubMed, 1 synthesis or guideline pooled it.
- Outcomes of HIV-positive patients lost to follow-up in African treatment programmes.Tropical medicine & international health : TM & IH · 2017Pooled it
- An Interactive Voice Response Software to Improve the Quality of Life of People Living With HIV in Uganda: Randomized Controlled Trial.JMIR mHealth and uHealth · 2021Trial
- Characteristics of HIV-Infected Children at Enrollment into Care and at Antiretroviral Therapy Initiation in Central Africa.PloS one · 2017Trial
- Prevalence, Predictors, and Outcomes of HIV Care in HIV-Positive Clients Entering HIV Care With Advanced HIV Disease in Sub-Saharan Africa 2010-2022: Systematic Review and Meta-Analysis.Health science reports · 2024Article
- Factors associated with late initiation of antiretroviral therapy in Iran's HIV/AIDS surveillance data.Scientific reports · 2024Article
- Survival probability and factors associated with time to loss to follow-up and mortality among patients on antiretroviral treatment in central Kenya.BMC infectious diseases · 2022Article
- Late cART Initiation Consistently Driven by Late HIV Presentation: A Multicenter Retrospective Cohort Study in Taiwan from 2009 to 2019.Infectious diseases and therapy · 2022Article
- Temporal trends in pre-ART patient characteristics and outcomes before the test and treat era in Central Kenya.BMC infectious diseases · 2021Article
- A Rapid Screening Program for Histoplasmosis, Tuberculosis, and Cryptococcosis Reduces Mortality in HIV Patients from Guatemala.Journal of fungi (Basel, Switzerland) · 2021Article
- Article
- High burden of cryptococcal antigenemia and meningitis among patients presenting at an emergency department in Maputo, Mozambique.PloS one · 2021Article
- Immunodeficiency at Antiretroviral Therapy Start: Five-Year Adult Data (2012-2017) Based on Evolving National Policies in Rural Mozambique.AIDS research and human retroviruses · 2020Article
- The evolution and adoption of World Health Organization policy guidelines on antiretroviral therapy initiation in sub-Saharan Africa: A scoping review.Southern African journal of HIV medicine · 2020Article
- Concurrent advanced HIV disease and viral load suppression in a high-burden setting: Findings from the 2015-6 ZIMPHIA survey.PloS one · 2020Article
- Article
- Early outcomes after implementation of treat all in Rwanda: an interrupted time series study.Journal of the International AIDS Society · 2019Observational
- Article
- Do HIV treatment eligibility expansions crowd out the sickest? Evidence from rural South Africa.Tropical medicine & international health : TM & IH · 2018Observational
- Global Trends in CD4 Cell Count at the Start of Antiretroviral Therapy: Collaborative Study of Treatment Programs.Clinical infectious diseases : an official publication of the Infectious Diseases Society of America · 2018Article
- Trends, treatment outcomes, and determinants for attrition among adult patients in care at a large tertiary HIV clinic in Nairobi, Kenya: a 2004-2015 retrospective cohort study.HIV/AIDS (Auckland, N.Z.) · 2018Article
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Funding
Abstract
backgroundInitiation of antiretroviral therapy (ART) in the advanced stages of HIV infection remains a major challenge in sub-Saharan Africa. This study was conducted to better understand barriers and enablers to timely ART initiation in Rwanda where ART coverage is high and national ART eligibility guidelines first expanded in 2007-2008.
methodsUsing data on 6326 patients (≥15 years) at five Rwandan clinics, we assessed trends and correlates of CD4 cell count at ART initiation and the proportion initiating ART with advanced HIV disease (CD4 <200 cells/μl or WHO stage IV).
resultsOut of 6326 patients, 4486 enrolling in HIV care initiated ART with median CD4 cell count of 211 cells/μl [interquartile range: 131-300]. Median CD4 cell counts at ART initiation increased from 183 cells/μl in 2007 to 293 cells/μl in 2011-2012, and the proportion with advanced HIV disease decreased from 66.2 to 29.4%. Factors associated with a higher odds of advanced HIV disease at ART initiation were male sex [adjusted odds ratios (AOR) = 1.7; 95% confidence interval (CI): 1.3-2.1] and older age (AOR46-55+vs.<25 = 2.3; 95% CI: 1.2-4.3). Among those initiating ART more than 1 year after enrollment in care, those who had a gap in care of 12 or more months prior to ART initiation had higher odds of advanced HIV disease (AOR = 5.2; 95% CI: 1.2-21.1).
conclusionMarked improvements in the median CD4 cell count at ART initiation and proportion initiating ART with advanced HIV disease were observed following the expansion of ART eligibility criteria in Rwanda. However, sex disparities in late treatment initiation persisted through 2011-2012, and appeared to be driven by later diagnosis and/or delayed linkage to care among men.
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