title: Factors associated with antiretroviral treatment initiation amongst HIV-positive individuals linked to care within a universal test and treat programme: early findings of the ANRS 12249 TasP trial in rural South Africa.
abstract: Prompt uptake of antiretroviral treatment (ART) is essential to ensure the success of universal test and treat (UTT) strategies to prevent HIV transmission in high-prevalence settings. We describe ART initiation rates and associated factors within an ongoing UTT cluster-randomized trial in rural South Africa. HIV-positive individuals were offered immediate ART in the intervention arm vs. national guidelines recommended initiation (CD4≤350 cells/mm(3)) in the control arm. We used data collected up to July 2015 among the ART-eligible individuals linked to TasP clinics before January 2015. ART initiation rates at one (M1), three (M3) and six months (M6) from baseline visit were described by cluster and CD4 count strata (cells/mm(3)) and other eligibility criteria: ≤100; 100-200; 200-350; CD4>350 with WHO stage 3/4 or pregnancy; CD4>350 without WHO stage 3/4 or pregnancy. A Cox model accounting for covariate effect changes over time was used to assess factors associated with ART initiation. The 514 participants had a median [interquartile range] follow-up duration of 1.08 [0.69; 2.07] months until ART initiation or last visit. ART initiation rates at M1 varied substantially (36.9% in the group CD4>350 without WHO stage 3/4 or pregnancy, and 55.2-71.8% in the three groups with CD4≤350) but less at M6 (from 85.3% in the first group to 96.1-98.3% in the three other groups). Factors associated with lower ART initiation at M1 were a higher CD4 count and attending clinics with both high patient load and higher cluster HIV prevalence. After M1, having a regular partner was the only factor associated with higher likelihood of ART initiation. These findings suggest good ART uptake within a UTT setting, even among individuals with high CD4 count. However, inadequate staffing and healthcare professional practices could result in prioritizing ART initiation in patients with the lowest CD4 counts.
authors.affiliation: a INSERM, UMR_S 912, « Sciences Economiques & Sociales de la Santé et Traitement de l'Information Médicale » (SESSTIM) , Marseille , France.|b Aix Marseille Université, UMR_S 912, IRD , Marseille , France.
authors.forename: Sylvie
authors.initials: S
authors.lastname: Boyer
authors.affiliation: c Africa Centre for Population Health , University of KwaZulu-Natal , Somkhele , South Africa.|d Research Department of Infection and Population Health , University College London , London , UK.
authors.forename: Collins
authors.initials: C
authors.lastname: Iwuji
authors.affiliation: a INSERM, UMR_S 912, « Sciences Economiques & Sociales de la Santé et Traitement de l'Information Médicale » (SESSTIM) , Marseille , France.|b Aix Marseille Université, UMR_S 912, IRD , Marseille , France.|e ORS PACA, Observatoire Régional de la Santé Provence-Alpes-Côte d'Azur , Marseille , France.
authors.forename: Andréa
authors.initials: A
authors.lastname: Gosset
authors.affiliation: a INSERM, UMR_S 912, « Sciences Economiques & Sociales de la Santé et Traitement de l'Information Médicale » (SESSTIM) , Marseille , France.|b Aix Marseille Université, UMR_S 912, IRD , Marseille , France.|e ORS PACA, Observatoire Régional de la Santé Provence-Alpes-Côte d'Azur , Marseille , France.
authors.forename: Camelia
authors.initials: C
authors.lastname: Protopopescu
authors.affiliation: c Africa Centre for Population Health , University of KwaZulu-Natal , Somkhele , South Africa.
authors.forename: Nonhlanhla
authors.initials: N
authors.lastname: Okesola
authors.affiliation: f ISPED, Centre Inserm U1219 Bordeaux Population Health, University of Bordeaux , Bordeaux , France.|g INSERM, ISPED, Centre Inserm U1219 Bordeaux Population Health , Bordeaux , France.
authors.forename: Mélanie
authors.initials: M
authors.lastname: Plazy
authors.affiliation: a INSERM, UMR_S 912, « Sciences Economiques & Sociales de la Santé et Traitement de l'Information Médicale » (SESSTIM) , Marseille , France.|b Aix Marseille Université, UMR_S 912, IRD , Marseille , France.|e ORS PACA, Observatoire Régional de la Santé Provence-Alpes-Côte d'Azur , Marseille , France.
authors.forename: Bruno
authors.initials: B
authors.lastname: Spire
authors.affiliation: f ISPED, Centre Inserm U1219 Bordeaux Population Health, University of Bordeaux , Bordeaux , France.|g INSERM, ISPED, Centre Inserm U1219 Bordeaux Population Health , Bordeaux , France.
authors.forename: Joanna
authors.initials: J
authors.lastname: Orne-Gliemann
authors.affiliation: c Africa Centre for Population Health , University of KwaZulu-Natal , Somkhele , South Africa.|d Research Department of Infection and Population Health , University College London , London , UK.|h Faculty of Medicine and Faculty of Human, Social and Mathematical Sciences , University of Southampton , Southampton , UK.
authors.forename: Nuala
authors.initials: N
authors.lastname: McGrath
authors.affiliation: c Africa Centre for Population Health , University of KwaZulu-Natal , Somkhele , South Africa.|i Faculty of Medical Sciences , University College London , London , UK.
authors.forename: Deenan
authors.initials: D
authors.lastname: Pillay
authors.affiliation: f ISPED, Centre Inserm U1219 Bordeaux Population Health, University of Bordeaux , Bordeaux , France.|g INSERM, ISPED, Centre Inserm U1219 Bordeaux Population Health , Bordeaux , France.
authors.forename: François
authors.initials: F
authors.lastname: Dabis
authors.affiliation: c Africa Centre for Population Health , University of KwaZulu-Natal , Somkhele , South Africa.|j CEPED (Centre Population & Développement-UMR 196-Paris Descartes/IRD) , IRD (Institut de Recherche pour le Développement) , Paris , France.
authors.forename: Joseph
authors.initials: J
authors.lastname: Larmarange
mesh_terms: D000293:Adolescent; D000328:Adult; D019380:Anti-HIV Agents / Q000627:therapeutic use*; D023241:Antiretroviral Therapy, Highly Active; D018791:CD4 Lymphocyte Count; D003266:Continuity of Patient Care / Q000458:organization & administration; D004334:Drug Administration Schedule; D005260:Female; D015658:HIV Infections / Q000175:diagnosis* / Q000188:drug therapy* / Q000523:psychology; D006801:Humans; D008297:Male; D008875:Middle Aged; D011247:Pregnancy; D012424:Rural Population / Q000706:statistics & numerical data; D012923:Social Class; D012959:Socioeconomic Factors; D013019:South Africa / Q000453:epidemiology; D013997:Time Factors; D055815:Young Adult
chemical_list: D019380:Anti-HIV Agents
keywords: HIV infection; South Africa; TasP trial; early antiretroviral treatment; universal test and treat strategy