ArticleClinical infectious diseases : an official publication of the Infectious Diseases Society of America2021
Effects of National Adoption of Treat-All Guidelines on Pre-Antiretroviral Therapy (ART) CD4 Testing and Viral Load Monitoring After ART initiation: A Regression Discontinuity Analysis.
Article in Clinical infectious diseases : an official publication of the Infectious Diseases Society of America, 2021. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 23 papers, 1 of them a synthesis that pooled it.
What it found
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The trial behind it
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Who cites it
23 citing papers in PubMed, 1 synthesis or guideline pooled it, 29 citations in OpenAlex.
- Viral load monitoring for people living with HIV in the era of test and treat: progress made and challenges ahead - a systematic review.BMC public health · 2022Pooled it
- Evolution of ART Medication Adherence Support and Monitoring Across IeDEA Sites: Results From Three Waves of Consortium-Wide Site Assessment Surveys, 2017, 2020 and 2023.Journal of the International AIDS Society · 2026Article
- 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
- Trends in frequency of HIV viral load and CD4 cell count monitoring among Asian cohort of adults with HIV: an analysis of the TREAT Asia HIV Observational Database, 2003-2018.medRxiv : the preprint server for health sciences · 2026Article
- Decreasing Adult Prevalence of Advanced HIV Disease From 2 Population-Based HIV Impact Assessments in Eswatini, Lesotho, Malawi, Tanzania, Uganda, Zambia, and Zimbabwe, 2015-2023.Open forum infectious diseases · 2026Article
- Evaluation of point-of-care Alere Pima CD4 test for low CD4 cell counts test in Uganda.Scientific reports · 2025Article
- Recommendation on the use of viral load tests and exclusion of CD4 tests as proxies for HIV medical visits.Annals of epidemiology · 2025Article
- Global Trends in CD4 Count Measurement and Distribution at First Antiretroviral Treatment Initiation.Clinical infectious diseases : an official publication of the Infectious Diseases Society of America · 2025Article
- Transitions through the HIV continuum of care in people enrolling in care with advanced HIV disease in Latin America.IJID regions · 2025Article
- Monitoring for advanced disease in the universal test and treat era: trends in CD4 count testing in South Africa.BMC global and public health · 2025Article
- Sensitivity Analysis of Life History Data with Loss to Follow-up: Extending Multistate Models Using Multiple Imputation.Proceedings. American Statistical Association. Annual Meeting · 2024Article
- Cost-effectiveness of differentiated care models that incorporate economic strengthening for HIV antiretroviral therapy adherence: a systematic review.Cost effectiveness and resource allocation : C/E · 2024Review
- Long-term HIV care outcomes under universal HIV treatment guidelines: A retrospective cohort study in 25 countries.PLoS medicine · 2024Article
- The effect of the Universal Test and Treat policy uptake on CD4 count testing and incidence of opportunistic infections among people living with HIV infection in Cameroon: a retrospective analysis of routine data.Dialogues in health · 2023Article
- Standard of care in advanced HIV disease: review of HIV treatment guidelines in six sub-Saharan African countries.AIDS research and therapy · 2023Review
- Impact of HIV treat-all and complementary policies on ART linkage in 13 PEPFAR-supported African countries.BMC health services research · 2023Article
- Article
- Long-Term Benefits from Early Antiretroviral Therapy Initiation in HIV Infection.NEJM evidence · 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
- Real-world use and outcomes of dolutegravir-containing antiretroviral therapy in HIV and tuberculosis co-infection: a site survey and cohort study in sub-Saharan Africa.Journal of the International AIDS Society · 2022Article
Corrections and comments
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Authors and funding
14 authors at 8 institutions in 6 countries.
Funding
Abstract
backgroundThe World Health Organization's Treat-All guidance recommends CD4 testing before initiating antiretroviral therapy (ART), and routine viral load (VL) monitoring (over CD4 monitoring) for patients on ART.
methodsWe used regression discontinuity analyses to estimate changes in CD4 testing and VL monitoring among 547 837 ART-naive patients enrolling in human immunodeficiency virus (HIV) care during 2006-2018 at 225 clinics in 26 countries where Treat-All policies were adopted. We examined CD4 testing within 12 months before and VL monitoring 6 months after ART initiation among adults (≥20 years), adolescents (10-19 years), and children (0-9 years) in low/lower-middle-income countries (L/LMICs) and high/upper-middle-income countries (H/UMICs).
resultsTreat-All adoption led to an immediate decrease in pre-ART CD4 testing among adults in L/LMICs, from 57.0% to 48.1% (-8.9 percentage points [pp]; 95% CI: -11.0, -6.8), and a small increase in H/UMICs, from 90.1% to 91.7% (+1.6pp; 95% CI: 0.2, 3.0), with no changes among adolescents or children; decreases in pre-ART CD4 testing accelerated after Treat-All adoption in L/LMICs. In L/LMICs, VL monitoring after ART initiation was low among all patients in L/LMICs before Treat-All; while there was no immediate change at Treat-All adoption, VL monitoring trends significantly increased afterwards. VL monitoring increased among adults immediately after Treat-All adoption, from 58.2% to 61.1% (+2.9pp; 95% CI: 0.5, 5.4), with no significant changes among adolescents/children.
conclusionsWhile on-ART VL monitoring has improved in L/LMICs, Treat-All adoption has accelerated and disparately worsened suboptimal pre-ART CD4 monitoring, which may compromise care outcomes for individuals with advanced HIV.
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