Kluberg, SA;
Fox, MP;
LaValley, M;
Pillay, D;
Bärnighausen, T;
Bor, J;
(2018)
Do HIV treatment eligibility expansions crowd out the sickest? Evidence from rural South Africa.
Tropical Medicine & International Health
, 23
(9)
pp. 968-979.
10.1111/tmi.13122.
Preview |
Text
Do HIV treatment eligibility expansions crowd out the sickest Evidence from rural South Africa.pdf - Published Version Download (554kB) | Preview |
Abstract
OBJECTIVE: The 2015 WHO recommendation to initiate all HIV patients on antiretroviral therapy (ART) at diagnosis could potentially overextend health systems and crowd out sicker patients, mitigating the policy's impact. We evaluate whether South Africa's prior eligibility expansion from CD4 ≤200 to CD4 ≤350 cells/μL reduced ART uptake in the sickest patients. METHODS: Using data on all patients presenting to the Hlabisa HIV Treatment and Care Program in KwaZulu-Natal from April 2010 - June 2012 (n=13,809), we assessed the impact of the August 2011 eligibility expansion on the number of patients seeking care, number initiating ART, and time from HIV diagnosis to ART initiation among patients always eligible (CD4 0-200), newly eligible (CD4 201-350), and not yet eligible by CD4 count (>350). We used interrupted time series methods to control for long-run trends and isolate the effect of the policy. RESULTS: Expanding ART eligibility led to an increased number of patients initiating ART per month [+95.5; 95% CI (-1.3; 192.3)]. Newly eligible patients (CD4 201-350) initiated treatment 47% faster than before (95% CI 19%; 82%), while the sickest patients (CD4 ≤200) saw no decline in the monthly number of patients initiating treatment or the rate of treatment uptake. CONCLUSION: The Hlabisa program successfully extended ART to patients with CD4 ≤350 cells/μL, while ensuring that the sickest patients did not experience delays in ART initiation. Treatment programs must be vigilant to maintain quality of care for the sickest as countries move to treat all patients irrespective of CD4 count. This article is protected by copyright. All rights reserved.
| Type: | Article |
|---|---|
| Title: | Do HIV treatment eligibility expansions crowd out the sickest? Evidence from rural South Africa |
| Location: | England |
| Open access status: | An open access version is available from UCL Discovery |
| DOI: | 10.1111/tmi.13122 |
| Publisher version: | https://doi.org/10.1111/tmi.13122 |
| Language: | English |
| Additional information: | Copyright © 2018 The Authors. Tropical Medicine & International Health Published by John Wiley & Sons Ltd. This is an open access article under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/4.0/), which permits use, distribution and reproduction in any medium, provided the original work is properly cited. |
| Keywords: | South Africa, adults, antiretroviral therapy, continuity of care, guidelines |
| UCL classification: | UCL UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences > Faculty of Medical Sciences UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences > Faculty of Medical Sciences > Div of Infection and Immunity |
| URI: | https://discovery.ucl.ac.uk/id/eprint/10053100 |
Archive Staff Only
 |
View Item |
