SEARCH Human Immunodeficiency Virus (HIV) Streamlined Treatment Intervention Reduces Mortality at a Population Level in Men With Low CD4 Counts.
Clin Infect Dis
; 73(7): e1938-e1945, 2021 10 05.
Article
em En
| MEDLINE
| ID: mdl-33783495
ABSTRACT
BACKGROUND:
We tested the hypothesis that patient-centered, streamlined human immunodeficiency virus (HIV) care would achieve lower mortality than the standard treatment model for persons with HIV and CD4â ≤â 350/uL in the setting of population-wide HIV testing.METHODS:
In the SEARCH (Sustainable East Africa Research in Community Health) Study (NCT01864603), 32 communities in rural Uganda and Kenya were randomized to country-guided antiretroviral therapy (ART) versus streamlined ART care that included rapid ART start, visit spacing, flexible clinic hours, and welcoming environment. We assessed persons with HIV and CD4â ≤â 350/uL, ART eligible in both arms, and estimated the effect of streamlined care on ART initiation and mortality at 3 years. Comparisons between study arms used a cluster-level analysis with survival estimates from Kaplan-Meier; estimates of ART start among ART-naive persons treated death as a competing risk.RESULTS:
Among 13 266 adults with HIV, 2973 (22.4%) had CD4â ≤â 350/uL. Of these, 33% were new diagnoses, and 10% were diagnosed but ART-naive. Men with HIV were almost twice as likely as women with HIV to have CD4â ≤â 350/uL and be untreated (15% vs 8%, respectively). Streamlined care reduced mortality by 28% versus control (risk ratio [RR]â =â 0.72; 95% confidence interval [CI] .56, .93; Pâ =â .02). Despite eligibility in both arms, persons with CD4â ≤â 350/uL started ART faster under streamlined care versus control (76% vs 43% by 12 months, respectively; Pâ <â .001). Mortality was reduced substantially more among men (RRâ =â 0.61; 95% CI .43, .86; Pâ =â .01) than among women (RRâ =â 0.90; 95% CI .62, 1.32; Pâ =â .58).CONCLUSIONS:
After population-based HIV testing, streamlined care reduced population-level mortality among persons with HIV and CD4â ≤â 350/uL, particularly among men. Streamlined HIV care models may play a key role in global efforts to reduce AIDS deaths.Palavras-chave
Texto completo:
1
Bases de dados:
MEDLINE
Assunto principal:
Infecções por HIV
/
Fármacos Anti-HIV
Tipo de estudo:
Clinical_trials
Limite:
Adult
/
Female
/
Humans
/
Male
País/Região como assunto:
Africa
Idioma:
En
Revista:
Clin Infect Dis
Assunto da revista:
DOENCAS TRANSMISSIVEIS
Ano de publicação:
2021
Tipo de documento:
Article
País de afiliação:
Uganda