Effects of the implementation of the HIV Treat All guidelines on key ART treatment outcomes in Namibia

• Main Authors: Burnett-Zieman, B. (Author), Forsythe, S. (Author), Geibel, S. (Author), Granger, K. (Author), Luu, M. (Author), Mdala, J. (Author), Stoman, L. (Author), Vu, L. (Author), Zegeye, A. (Author)
• Format: Article
• Language: English
• Published: Public Library of Science 2021
• Subjects: adult; Adult; anti human immunodeficiency virus agent; Anti-HIV Agents; antiretroviral therapy; art therapy; article; blood; cohort analysis; controlled study; disease eradication; Disease Eradication; drug effect; epidemic; Epidemics; female; Female; follow up; government; health care planning; Health Plan Implementation; health status; HIV Infections; human; Human immunodeficiency virus; Human immunodeficiency virus infection; Humans; interview; Longitudinal Studies; longitudinal study; Lost to Follow-Up; major clinical study; male; Male; medical record review; middle aged; Middle Aged; Namibia; nonhuman; outcome assessment; practice guideline; Practice Guidelines as Topic; procedures; randomized controlled trial; Retrospective Studies; retrospective study; time perception; treatment outcome; Treatment Outcome; Viral Load; virus load
• Online Access: View Fulltext in Publisher

 Background: This study aimed to help the Namibian government understand the impact of Treat All implementation (started on April 1, 2017) on key antiretroviral therapy (ART) outcomes, and how this transition impacts progress toward the UNAIDS's 90-90-90 HIV targets. Methods: We collected clinical records from two separate cohorts (before and after treat-all) of ART patients in 10 high- and medium-volume facilities in 6 northern Namibia districts. Each cohort contains 12-month data on patients' scheduled appointments and visits, health status, and viral load results. We also measured patients' wait time and perceptions of service quality using exit interviews with 300 randomly selected patients (per round). We compared ART outcomes of the two cohorts: ART initiation within 7 days from diagnosis, loss to followup (LTFU), missed scheduled appointments for at least 30 days, and viral suppression using unadjusted and adjusted analyses. Results: Among new ART clients (on ART for less than 3 months or had not yet initiated treatment as of the start date for the ART record review period), rapid ART initiation (within 7 days from diagnosis) was 5.2 times higher after Treat All than that among clients assessed before the policy took effect [AOR: 5.2 (3.8-6.9)]. However, LTFU was higher after Treat All roll-out compared to before Treat All [AOR: 1.9 (1.3-2.8)]. Established ART clients (on ART treatment for at least three months at the start date of the ART record review period) had over 3 times greater odds of achieving viral suppression after Treat All roll-out compared to established ART clients assessed before Treat All [AOR: 3.1 (1.6-5.9)]. Conclusions: and recommendations The findings indicate positive effect of the "Treat All" implementation on ART initiation and viral suppression, and negative effect on LTFU. Additionally, by April 2018, Namibia seems to have reached the UNAIDS's 90-90-90 targets. © 2020 Public Library of Science. All rights reserved.