ArticleJournal of clinical epidemiology2021
Regression discontinuity analysis demonstrated varied effect of Treat-All on CD4 testing among Southern African countries.
Article in Journal of clinical epidemiology, 2021. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 7 papers.
What it found
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Who cites it
7 citing papers in PubMed.
- Impact of the 2013 WHO guidelines for screening and treatment of cervical pre-cancerous lesions on women's screening uptake, by HIV-status, in Eastern and Southern Africa: a regression discontinuity design analysis.Reproductive health · 2026Article
- Immunodeficiency, HIV Viremia, and Incident Anal Cancer Among People With HIV in South Africa.Open forum infectious diseases · 2025Article
- Evaluation of point-of-care Alere Pima CD4 test for low CD4 cell counts test in Uganda.Scientific reports · 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
- 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
- The impact of evolving maternal antiretroviral therapy guidelines on vertical transmission of HIV in the Western Cape, South Africa.PloS one · 2025Article
- Associations of inter-annual rainfall decreases with subsequent HIV outcomes for persons with HIV on antiretroviral therapy in Southern Africa: a collaborative analysis of cohort studies.BMC infectious diseases · 2023Article
Corrections and comments
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Authors and funding
14 authors.
Funding
Abstract
objectiveTo determine whether Treat-All policy impacted laboratory testing practices of antiretroviral therapy (ART) programs in Southern Africa. STUDY DESIGN AND
settingWe used HIV cohort data from Lesotho, Malawi, Mozambique, South Africa, Zambia and Zimbabwe in a regression discontinuity design to estimate changes in pre-ART CD4 testing and viral load monitoring following national Treat-all adoption that occurred during 2016 to 2017. This study included more than 230,000 ART-naïve people living with HIV (PLHIV) aged five years or older who started ART within two years of national Treat-All adoption.
resultsWe found pre-ART CD4 testing decreased following adoption of Treat-All recommendations in Malawi (-21.4 percentage points (pp), 95% confidence interval, CI: -26.8, -16.0) and in Mozambique (-8.8pp, 95% CI: -14.9, -2.8), but increased in Zambia (+2.7pp, 95% CI: +0.4, +5.1). Treat-All policy had no effect on viral load monitoring, except among females in South Africa (+7.1pp, 95% CI: +1.1, +13.0).
conclusionTreat-All policy expanded ART eligibility, but led to reductions in pre-ART CD4 testing in some countries that may weaken advanced HIV disease management. Continued and expanded support of CD4 and viral load laboratory capacity is needed to further improve treatment successes and allow for uniform evaluation of ART implementation across Southern Africa.
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