Observational studyTropical medicine & international health : TM & IH2018
Do HIV treatment eligibility expansions crowd out the sickest? Evidence from rural South Africa.
Observational study in Tropical medicine & international health : TM & IH, 2018. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 7 papers.
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Who cites it
7 citing papers in PubMed, 12 citations in OpenAlex.
- Cohort profile: the South African National Health Laboratory Service (NHLS) National HIV Cohort.BMJ open · 2022Article
- CD4+ T-Cell Count at Antiretroviral Therapy Initiation in the "Treat-All" Era in Rural South Africa: An Interrupted Time Series Analysis.Clinical infectious diseases : an official publication of the Infectious Diseases Society of America · 2022Article
- Predictors of antiretroviral therapy initiation in eThekwini (Durban), South Africa: Findings from a prospective cohort study.PloS one · 2021Article
- Changes in rapid HIV treatment initiation after national "treat all" policy adoption in 6 sub-Saharan African countries: Regression discontinuity analysis.PLoS medicine · 2019Article
- The crowd-out effect of a mass casualty incident: Experience from a dust explosion with multiple burn injuries.Medicine · 2019Observational
- Early outcomes after implementation of treat all in Rwanda: an interrupted time series study.Journal of the International AIDS Society · 2019Observational
- Failure to initiate HIV treatment in patients with high CD4 counts: evidence from demographic surveillance in rural South Africa.Tropical medicine & international health : TM & IH · 2018Article
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Authors and funding
6 authors at 3 institutions in 4 countries.
Funding
Abstract
objectiveThe 2015 WHO recommendation to initiate all HIV patients on antiretroviral therapy (ART) at diagnosis could potentially overextend health systems and crowd out sicker patients, mitigating the policy's impact. We evaluate whether South Africa's prior eligibility expansion from CD4 ≤ 200 to CD4 ≤ 350 cells/μl reduced ART uptake in the sickest patients.
methodsUsing data on all patients presenting to the Hlabisa HIV Treatment and Care Programme in KwaZulu-Natal from April 2010 to June 2012 (n = 13 809), we assessed the impact of the August 2011 eligibility expansion on the number of patients seeking care, number initiating ART and time from HIV diagnosis to ART initiation among patients always eligible (CD4 0-200), newly eligible (CD4 201-350) and not yet eligible by CD4 count (>350). We used interrupted time series methods to control for long-run trends and isolate the effect of the policy.
resultsExpanding ART eligibility led to an increased number of patients initiating ART per month [+95.5; 95% CI (-1.3; 192.3)]. Newly eligible patients (CD4 201-350) initiated treatment 47% faster than before (95% CI 19%; 82%), while the sickest patients (CD4 ≤ 200) saw no decline in the monthly number of patients initiating treatment or the rate of treatment uptake.
conclusionThe Hlabisa programme successfully extended ART to patients with CD4 ≤ 350 cells/μl, while ensuring that the sickest patients did not experience delays in ART initiation. Treatment programmes must be vigilant to maintain quality of care for the sickest as countries move to treat all patients irrespective of CD4 count.
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