Evidence map›Paper›PMID 31647613›Full record

ArticleJournal of the International AIDS Society2019

Feasibility of antiretroviral therapy initiation under the treat-all policy under routine conditions: a prospective cohort study from Eswatini.

Bernhard Kerschberger, Kiran Jobanputra, Michael Schomaker, Serge M Kabore, Roger Teck, Edwin Mabhena, Nomthandazo Lukhele, Barbara Rusch, Andrew Boulle, Iza Ciglenecki

Abstract read
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In one paragraph

Article in Journal of the International AIDS Society, 2019. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 10 papers.

0numbers the graph read from it
0cells of the map it votes in
10citing papers in PubMed
–field-weighted citation impact
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

10 citing papers in PubMed.

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4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

10 authors.

Bernhard KerschbergerMédecins Sans Frontières (Operational Centre Geneva), Mbabane, Eswatini.ORCID 0000-0003-0525-7262
Kiran JobanputraThe Manson Unit, Médecins Sans Frontières, London, United Kingdom.
Michael SchomakerCentre for Infectious Disease Epidemiology and Research, School of Public Health and Family Medicine, University of Cape Town, Cape Town, South Africa.ORCID 0000-0002-8475-0591
Serge M KaboreMédecins Sans Frontières (Operational Centre Geneva), Mbabane, Eswatini.
Roger TeckThe Manson Unit, Médecins Sans Frontières, London, United Kingdom.
Edwin MabhenaMédecins Sans Frontières (Operational Centre Geneva), Mbabane, Eswatini.
Nomthandazo LukheleSwaziland National AIDS Programme (SNAP), Ministry of Health, Mbabane, Eswatini.
Barbara RuschMédecins Sans Frontières (Operational Centre Geneva), Geneva, Switzerland.
Andrew BoulleCentre for Infectious Disease Epidemiology and Research, School of Public Health and Family Medicine, University of Cape Town, Cape Town, South Africa.ORCID 0000-0002-7713-8062
Iza CigleneckiMédecins Sans Frontières (Operational Centre Geneva), Geneva, Switzerland.

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

introductionThe World Health Organization recommends the Treat-All policy of immediate antiretroviral therapy (ART) initiation, but questions persist about its feasibility in resource-poor settings. We assessed the feasibility of Treat-All compared with standard of care (SOC) under routine conditions.

methodsThis prospective cohort study from southern Eswatini followed adults from HIV care enrolment to ART initiation. Between October 2014 and March 2016, Treat-All was offered in one health zone and SOC according to the CD4 350 and 500 cells/mm

resultsOf the 1726 (57.3%) patients enrolled under Treat-All and 1287 (42.7%) under SOC, cumulative three-month ART initiation was higher under Treat-All (91%) than SOC (74%; p < 0.001) with a median time to ART of 1 (IQR 0 to 14) and 10 (IQR 2 to 117) days respectively. Under Treat-All, ART initiation was higher in pregnant women (vs. non-pregnant women: adjusted hazard ratio (aHR) 1.96, 95% confidence interval (CI) 1.70 to 2.26), those with secondary education (vs. no formal education: aHR 1.48, 95% CI 1.12 to 1.95), and patients with an HIV-positive diagnosis before care enrolment (aHR 1.22, 95% CI 1.10 to 1.36). ART initiation was lower in patients attending secondary care facilities (aHR 0.64, 95% CI 0.58 to 0.72) and for CD4 351 to 500 when compared with CD4 201 to 350 cells/mm

conclusionsART initiation was high under Treat-All and without evidence of de-prioritization of patients with advanced HIV disease. Additional studies are needed to understand the long-term impact of Treat-All on patient outcomes.

Indexed as

AdultAnti-HIV AgentsCD4 Lymphocyte CountEligibility DeterminationEswatiniFeasibility StudiesFemaleHIV InfectionsHumansKaplan-Meier EstimateMaleMiddle AgedPregnancyProportional Hazards ModelsProspective StudiesTime-to-TreatmentAnti-HIV AgentsART initiationEswatinilinkagetreat alltreatment cascadeuniversal ART

Identifiers

PMID31647613
PMCPMC6812490

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Registered trials

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Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.