Trial reportJournal of the International AIDS Society2020
Early access to antiretroviral therapy versus standard of care among HIV-positive participants in Eswatini in the public health sector: the MaxART stepped-wedge randomized controlled trial.
Trial report in Journal of the International AIDS Society, 2020. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 20 papers, 1 of them a synthesis that pooled 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.
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.
Who cites it
20 citing papers in PubMed, 1 synthesis or guideline pooled it, 38 citations in OpenAlex.
- Attrition one year after starting antiretroviral therapy before and after the programmatic implementation of HIV "Treat All" in Sub-Saharan Africa: a systematic review and meta-analysis.BMC infectious diseases · 2023Pooled it
- Early access to antiretroviral therapy versus standard of care among HIV-positive participants in Eswatini in the public health sector: the MaxART stepped-wedge randomized controlled trial.Journal of the International AIDS Society · 2020Trial
- HIV disease progression following WHO treat all guideline adoption among people enrolled in HIV care in Central Africa: A multistate analysis.Annals of epidemiology · 2026Article
- Insights from a trend analysis of HIV indicators using Population-based HIV Impact Assessment (PHIA) surveys in Zimbabwe.BMC public health · 2026Article
- Retention and predictors of loss-to-follow-up among patients on antiretroviral therapy in the Test-and-Treat Era: evidence from a retrospective cohort study in Maputo, Mozambique.BMC infectious diseases · 2026Article
- Demographic and Socioeconomic Factors Associated With ART Nonadherence Among 15 Years and Older South Africans. Evidence From the 2022 Cross-Sectional Population-Based Household Survey.AIDS research and treatment · 2026Article
- Applications and implementation considerations for stepped-wedge designs in sub-Saharan Africa: a systematic review.Frontiers in epidemiology · 2026Review
- Sensitivity Analysis of Life History Data with Loss to Follow-up: Extending Multistate Models Using Multiple Imputation.Proceedings. American Statistical Association. Annual Meeting · 2024Article
- Long-term HIV care outcomes under universal HIV treatment guidelines: A retrospective cohort study in 25 countries.PLoS medicine · 2024Article
- Progress of the Gulf Cooperation Council (GCC) Countries Towards Achieving the 95-95-95 UNAIDS Targets: A Review.Journal of epidemiology and global health · 2023Review
- Association Between Time to Antiretroviral Therapy and Loss to Care Among Newly Diagnosed Rwandan People Living with Human Immunodeficiency Virus.AIDS research and human retroviruses · 2023Article
- Long-term outcomes of rapid antiretroviral NNRTI-based initiation among Thai youth living with HIV: a national registry database study.Journal of the International AIDS Society · 2023Article
- Is the Product Method More Efficient Than the Difference Method for Assessing Mediation?American journal of epidemiology · 2023Article
- HIV test-and-treat policy improves clinical outcomes in Zambian adults from Southern Province: a multicenter retrospective cohort study.Frontiers in public health · 2023Article
- Community mobilisation to achieve HIV testing and care goals.The lancet. HIV · 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
- Antiretroviral therapy initiation and retention among clients who received peer-delivered linkage case management and standard linkage services, Eswatini, 2016-2020: retrospective comparative cohort study.Archives of public health = Archives belges de sante publique · 2022Article
- Retention in care and predictors of attrition among HIV-infected patients who started antiretroviral therapy in Kinshasa, DRC, before and after the implementation of the 'treat-all' strategy.PLOS global public health · 2022Article
- Effects of implementing universal and rapid HIV treatment on initiation of antiretroviral therapy and retention in care in Zambia: a natural experiment using regression discontinuity.The lancet. HIV · 2021Article
- Estimating the natural indirect effect and the mediation proportion via the product method.BMC medical research methodology · 2021Article
Corrections and comments
PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.
Authors and funding
18 authors at 9 institutions in 6 countries.
Funding
Abstract
introductionThe WHO recommends antiretroviral treatment (ART) for all HIV-positive patients regardless of CD4 count or disease stage, referred to as "Early Access to ART for All" (EAAA). The health systems effects of EAAA implementation are unknown. This trial was implemented in a government-managed public health system with the aim to examine the "real world" impact of EAAA on care retention and viral suppression.
methodsIn this stepped-wedge randomized controlled trial, 14 public sector health facilities in Eswatini were paired and randomly assigned to stepwise transition from standard of care (SoC) to EAAA. ART-naïve participants ≥18 years who were not pregnant or breastfeeding were eligible for enrolment. We used Cox proportional hazard models with censoring at clinic transition to estimate the effects of EAAA on retention in care and retention and viral suppression combined.
resultsBetween September 2014 and August 2017, 3405 participants were enrolled. In SoC and EAAA respectively, 12-month HIV care retention rates were 80% (95% CI: 77 to 83) and 86% (95% CI: 83 to 88). The 12-month combined retention and viral suppression endpoint rates were 44% (95% CI: 40 to 48) under SoC compared to 80% (95% CI: 77 to 83) under EAAA. EAAA increased both retention (HR: 1·60, 95% CI: 1·15 to 2·21, p = 0.005) and retention and viral suppression combined (HR: 4.88, 95% CI: 2.96 to 8.05, p < 0.001). We also identified significant gaps in current health systems ability to provide viral load (VL) monitoring with 80% participants in SoC and 66% in EAAA having a missing VL at last contact.
conclusionsThe observed improvement in retention in care and on the combined retention and viral suppression provides an important co-benefit of EAAA to HIV-positive adults themselves, at least in the short term. Our results from this "real world" health systems trial strongly support EAAA for Eswatini and countries with similar HIV epidemics and health systems. VL monitoring needs to be scaled up for appropriate care management.
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Registered trials
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.