Timely initiation of HIV antiretroviral therapy in Haiti 2004–2018: a retrospective cohort study
Rev Panam Salud Publica
; 45, nov. 2021
Artículo
en Inglés
| PAHO-IRIS
| ID: phr-55177
Biblioteca responsable:
US1.1
ABSTRACT
[ABSTRACT]. Objective. To describe trends in timing of ART initiation for newly diagnosed people living with HIV before and after Haiti adopted its Test and Start policy for universal HIV antiretroviral therapy (ART) in July 2016, and to explore predictors of timely ART initiation for both newly and previously diagnosed people living with HIV following Test and Start adoption. Methods. This retrospective cohort study explored timing of ART initiation among 147 900 patients diagnosed with HIV at 94 ART clinics in 2004–2018 using secondary electronic medical record data. The study used survival analysis methods to assess time trends and risk factors for ART initiation. Results. Timely uptake of ART expanded with Test and Start, such that same-day ART initiation rates increased from 3.7% to 45.0%. However, only 11.0% of previously diagnosed patients initiated ART after Test and Start. In adjusted analyses among newly diagnosed people living with HIV, factors negatively associated with timely ART initiation included being a pediatric patient aged 0–14 years (HR = 0.23, p < 0.001), being male (HR = 0.92, p = 0.03), being 50+ years (HR = 0.87, p = 0.03), being underweight (HR = 0.79, p < 0.001), and having WHO stage 3 (HR = 0.73, p < 0.001) or stage 4 disease (HR = 0.49, p < 0.001). Variation in timely ART initiation by geographic department and health facility was observed. Conclusions. Haiti has made substantial progress in scaling up Test and Start, but further work is needed to enroll previously diagnosed patients and to ensure rapid ART in key patient subgroups. Further research is needed on facility and geographic factors and on strategies for improving timely ART initiation among vulnerable subgroups.
Texto completo:
Disponible
Colección:
Bases de datos de organismos internacionales
Contexto en salud:
Agenda de Salud Sostenible para las Américas
Problema de salud:
Objetivo 6: Sistemas de información para la salud
Base de datos:
PAHO-IRIS
Asunto principal:
VIH
/
Terapia Antirretroviral Altamente Activa
/
Ciencia de la Implementación
/
Haití
Tipo de estudio:
Estudio de etiología
/
Estudio observacional
/
Estudio pronóstico
/
Factores de riesgo
/
Revisión sistemática de estudios observacionales
Aspecto:
Investigación de implementación
País/Región como asunto:
Caribe
/
Haití
Idioma:
Inglés
Año:
2021
Tipo del documento:
Artículo