CD4+ T-Cell Count at Antiretroviral Therapy Initiation in the “Treat-All” Era in Rural South Africa: An Interrupted Time Series Analysis

Yapa, H Manisha, Kim, Hae-Young, Petoumenos, Kathy , Post, Frank A, Jiamsakul, Awachana, De Neve, Jan-Walter, Tanser, Frank, Iwuji, Collins, Baisley, Kathy, Shahmanesh, Maryam, Pillay, Deenan, Siedner, Mark J, Bärnighausen, Till and Bor, Jacob (2021) CD4+ T-Cell Count at Antiretroviral Therapy Initiation in the “Treat-All” Era in Rural South Africa: An Interrupted Time Series Analysis. Clinical Infectious Diseases . ISSN 1058-4838

Full content URL: https://doi.org/10.1093/cid%2Fciab650

Documents
CD4+ T-Cell Count at Antiretroviral Therapy Initiation in the “Treat-All” Era in Rural South Africa: An Interrupted Time Series Analysis
Published Open Access manuscript
[img]
[Download]
[img]
Preview
PDF
ciab650.pdf - Whole Document
Available under License Creative Commons Attribution 4.0 International.

1MB
Item Type:Article
Item Status:Live Archive

Abstract

Background
South Africa implemented universal test and treat (UTT) in September 2016 in an effort to encourage earlier initiation of antiretroviral therapy (ART).

Methods
We therefore conducted an interrupted time series (ITS) analysis to assess the impact of UTT on mean CD4 count at ART initiation among adults aged ≥16 years attending 17 public sector primary care clinics in rural South Africa, between July 2014 and March 2019.

Results
Among 20 599 individuals (69% women), CD4 counts were available for 74%. Mean CD4 at ART initiation increased from 317.1 cells/μL (95% confidence interval [CI], 308.6 to 325.6) 1 to 8 months prior to UTT to 421.0 cells/μL (95% CI, 413.0 to 429.0) 1 to 12 months after UTT, including an immediate increase of 124.2 cells/μL (95% CI, 102.2 to 146.1). However, mean CD4 count subsequently fell to 389.5 cells/μL (95% CI, 381.8 to 397.1) 13 to 30 months after UTT but remained above pre-UTT levels. Men initiated ART at lower CD4 counts than women (–118.2 cells/μL, 95% CI, –125.5 to –111.0) throughout the study.

Conclusions
Although UTT led to an immediate increase in CD4 count at ART initiation in this rural community, the long-term effects were modest. More efforts are needed to increase initiation of ART early in those living with human immunodeficiency virus, particularly men.

Keywords:hiv, adult, cd4 count determination procedure, primary health care, south africa, t-lymphocytes, anti-retroviral agents, community, interrupted time series analysis
Subjects:B Subjects allied to Medicine > B990 Subjects Allied to Medicine not elsewhere classified
Divisions:College of Social Science > Lincoln International Institute for Rural Health
ID Code:47329
Deposited On:17 Nov 2021 11:49

Repository Staff Only: item control page