ArticleBMC infectious diseases2015
Change of treatment guidelines and evolution of ART initiation in rural South Africa: data of a large HIV care and treatment programme.
Article in BMC infectious diseases, 2015. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 17 papers, 1 of them a synthesis that pooled it.
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Who cites it
17 citing papers in PubMed, 1 synthesis or guideline pooled it, 23 citations in OpenAlex.
- Specification of implementation interventions to address the cascade of HIV care and treatment in resource-limited settings: a systematic review.Implementation science : IS · 2017Pooled it
- Impact of increasing CD4 count threshold eligibility for antiretroviral therapy initiation on advanced HIV disease and tuberculosis prevalence and incidence in South Africa: an interrupted time series analysis.BMJ global health · 2025Article
- Cohort profile: the South African HIV Cancer Match (SAM) Study, a national population-based cohort.BMJ open · 2022Article
- HIV diagnosis period influences ART initiation: findings from a prospective cohort study in China.AIDS research and therapy · 2021Article
- The effect of eligibility for antiretroviral therapy on body mass index and blood pressure in KwaZulu-Natal, South Africa.Scientific reports · 2021Article
- Predictors of antiretroviral therapy initiation in eThekwini (Durban), South Africa: Findings from a prospective cohort study.PloS one · 2021Article
- 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
- Changes in rapid HIV treatment initiation after national "treat all" policy adoption in 6 sub-Saharan African countries: Regression discontinuity analysis.PLoS medicine · 2019Article
- HIV treatment regimens and adherence to national guidelines in Australia: an analysis of dispensing data from the Australian pharmaceutical benefits scheme.BMC public health · 2019Article
- Article
- When donor funding leaves: an interrupted time-series analysis of the impact of integrating direct HIV care and treatment into public health services in a region of Johannesburg.Cost effectiveness and resource allocation : C/E · 2019Article
- Do HIV treatment eligibility expansions crowd out the sickest? Evidence from rural South Africa.Tropical medicine & international health : TM & IH · 2018Observational
- Article
- ART initiation in an outpatient treatment center in Dakar, Senegal: A retrospective cohort analysis (1998-2015).PloS one · 2018Observational
- Treatment guidelines and early loss from care for people living with HIV in Cape Town, South Africa: A retrospective cohort study.PLoS medicine · 2017Observational
- Reduction in extrapulmonary tuberculosis in context of antiretroviral therapy scale-up in rural South Africa.Epidemiology and infection · 2017Article
- Effect of eliminating CD4-count thresholds on HIV treatment initiation in South Africa: An empirical modeling study.PloS one · 2017Article
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Authors and funding
6 authors at 3 institutions in 3 countries.
Funding
Abstract
backgroundWhile WHO recommendations are to treat people earlier and earlier, it will considerably increase the number of HIV infected people eligible for antiretroviral therapy (ART). In South Africa, a country which carries one of the highest HIV burden worldwide, very few studies are available on the impact of the ART guidelines on time to ART initiation in both individuals with low CD4 count and those newly eligible for ART. We thus aimed to describe ART initiation percentages in a large HIV programme in rural KwaZulu-Natal, South Africa, according to the temporal changes of national ART eligibility guidelines from 2007 to 2012.
methodsAdults who accessed the decentralized Hlabisa HIV treatment programme in 2007-2012 were included. Three periods following the temporal change of ART eligibility guidelines were defined (Period 1: until April 2010; Period 2: April 2010 - July 2011; Period 3: from August 2011). Percentages of ART initiation within three months of programme entry were estimated in men, in women of childbearing age (<40 years old) and in older women, and stratifying by CD4 count. Trend tests and logistic regression models were used to study the effects of change of guidelines on ART initiation percentages.
resultsIn individuals with CD4 count ≤200 cells/μL (N = 5709 men, N = 6743 women <40 years old and N = 2017 older women), percentages of ART initiation did not differ over time (p trend = 0.25; 0.28; and 0.14, respectively). In individuals with CD4 count = 201-350 cells/μL (N = 2680 men, N = 6086 women <40 years old and N = 1415 older women), percentages of ART initiation significantly increased over time (p trend <0.01 for the three groups): from 6 % in Period 1 to 20 % in Period 2 to 40 % in Period 3 in women of childbearing age, and from 7 % to 8-10 % to 42 % in men and in older women.
conclusionsAs temporal changes of guidelines, percentages of ART initiation significantly increased in newly ART eligible people and did not decrease in individuals with very low CD4 counts. It will be crucial to continue verifying the evolution of these percentages of ART initiation with future recommendations reaching near-to-universal access to ART, to ensure that individuals most in need of ART receive it.
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