Timely initiation of HIV antiretroviral therapy in Haiti 20042018: a retrospective cohort study

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...

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Bibliographic Details
Published in:Revista Panamericana de Salud Pública
Main Authors: Nancy Puttkammer, Canada Parrish, Yrvel Desir, Nathaelf Hyppolite, Nadjy Joseph, Lara Hall, Jean Guy Honoré, Ermane Robin, Georges Perrin, Kesner François
Format: Article in Journal/Newspaper
Language:English
Spanish
Portuguese
Published: Pan American Health Organization 2021
Subjects:
hiv
antiretroviral therapy
highly active
implementation science
haiti
Medicine
R
Arctic medicine. Tropical medicine
RC955-962
Public aspects of medicine
RA1-1270
Arctic
Online Access:https://doi.org/10.26633/RPSP.2021.139
https://doaj.org/article/4ed924603969434e8207731219d0a720
Description
Summary: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 20042018 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 014 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.

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