Observed time to HIV treatment initiation in the era of same-day initiation in Malawi, South Africa, and Zambia

Title

Observed time to HIV treatment initiation in the era of same-day initiation in Malawi, South Africa, and Zambia

Presenter

Amy Huber

Authors

A. Huber * (1), K. Hirasen (1), B. Phiri (2), T. Tchereni (3), A. Gunda (3), H. Shakwelele (2), P. Haembe (2), B. Matola (4), L. Mulenga (4), S. Rosen (5)

Institutions

(1) University of the Witwatersrand, Health Economics and Epidemiology Research Office, Johannesburg, South Africa, (2) Clinton Health Access Initiative, Zambia, Lusaka, Zambia, (3) Clinton Health Access Initiative, Malawi, Lilongwe, Malawi, (4) Ministry of Health, Lusaka, Zambia, (5) Boston University School of Public Health, Department of Global Health, Boston, United States

BACKGROUND: Since 2017 global guidelines have recommended 'same-day initiation' (SDI) of antiretroviral treatment (ART) for patients considered ready for treatment on the day of HIV diagnosis. Many countries in sub-Saharan Africa have incorporated a SDI option into national guidelines, but uptake of SDI is not well documented. We estimated average time to ART initiation at 12 public healthcare facilities in Malawi, 5 in South Africa, and 12 in Zambia.
METHODS: We sequentially enrolled patients who were eligible to start ART between January 2018 and June 2019 and reviewed their medical records from the point of HIV treatment eligibility (HIV diagnosis or first HIV-related interaction with the clinic) to the earlier of treatment initiation or 6 months. We estimated the proportion of patients initiating ART at their original healthcare facilities on the same day or within 7, 14, 30, or 180 days of baseline, stratified by country and gender.
RESULTS: We enrolled 850, 535, and 1,990 patients in Malawi, South Africa, and Zambia, respectively (Table 1). 88% of patients in Malawi, 57% in South Africa, and 91% in Zambia were offered and accepted SDI. In Malawi, most patients who did not receive SDI had also not initiated ART '¤6 months. In South Africa, an additional 13% of patients initiated '¤1 week, but 22% had no record of initiation '¤6 months. Among those who did initiate within 6 months in Zambia, nearly all started '¤1 week. There were no major differences by gender.

CONCLUSIONS: Uptake of same-day ART initiation is widespread in Malawi and nearly universal in Zambia but is considerably less common in South Africa. Limitations of the study include pre-COVID-19 data that do not reflect pandemic adaptations and potentially missing data for Zambia. South Africa may be able to increase overall ART coverage by reducing numbers of patients who do not initiate '¤6 months.

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