Impact of early antiretroviral therapy eligibility on HIV acquisition

• Verfasst von: Oldenburg, Catherine [VerfasserIn]
• Verfasst von: Bor, Jacob [VerfasserIn]
• Verfasst von: Harling, Guy [VerfasserIn]
• Verfasst von: Tanser, Frank [VerfasserIn]
• Verfasst von: Mutevedzi, Tinofa [VerfasserIn]
• Verfasst von: Shahmanesh, Maryam [VerfasserIn]
• Verfasst von: Seage, George R. [VerfasserIn]
• Verfasst von: De Gruttola, Victor [VerfasserIn]
• Verfasst von: Mimiaga, Matthew J. [VerfasserIn]
• Verfasst von: Mayer, Kenneth H. [VerfasserIn]
• Verfasst von: Pillay, Deenan [VerfasserIn]
• Verfasst von: Bärnighausen, Till [VerfasserIn]
• Titel: Impact of early antiretroviral therapy eligibility on HIV acquisition
• Titelzusatz: household-level evidence from rural South Africa
• Verf.angabe: Catherine E. Oldenburg, Jacob Bor, Guy Harling, Frank Tanser, Tinofa Mutevedzi, Maryam Shahmanesh, George R. Seage, Victor De Gruttola, Matthew J. Mimiaga, Kenneth H. Mayer, Deenan Pillay and Till Bärnighausen
• E-Jahr: 2018
• Jahr: [March 13, 2018]
• Umfang: 9 S.
• Illustrationen: Diagramme
• Fussnoten: Gesehen am 24.03.2020
• Titel Quelle: Enthalten in: AIDS <London>
• Ort Quelle: London [u.a.] : Lippincott Williams & Wilkins, 1987
• Jahr Quelle: 2018
• Band/Heft Quelle: 32(2018), 5, Seite 635-643
• ISSN Quelle: 1473-5571
• DOI: doi:10.1097/QAD.0000000000001737
• Datenträger: Online-Ressource
• Sprache: eng
• K10plus-PPN: 1693193558

Abstract

Objectives: We investigate the effect of immediate antiretroviral therapy (ART) eligibility on HIV incidence among HIV-uninfected household members. - Design: Regression discontinuity study arising from a population-based cohort. - Methods: Household members of patients seeking care at the Hlabisa HIV Treatment and Care Programme in rural KwaZulu-Natal South Africa between January 2007 and August 2011 with CD4+ cell counts up to 350 cells/μl were eligible for inclusion if they had at least two HIV tests and were HIV-uninfected at the time the index patient linked to care (N = 4115). Regression discontinuity was used to assess the intention-to-treat effect of immediate versus delayed ART eligibility on HIV incidence among household members. Exploiting the CD4+ cell count-based threshold rule for ART initiation (CD4+ < 200 cells/μl until August 2011), we used Cox proportional hazards models to compare outcomes for household members of patients who presented for care with CD4+ cell counts just above versus just below the ART initiation threshold. - Results: Characteristics of household members of index patients initiating HIV care were balanced between those with an index patient immediately eligible for ART (N = 2489) versus delayed for ART (N = 1626). There were 337 incident HIV infections among household members, corresponding to an HIV incidence of 2.4 infections per 100 person-years (95% confidence interval 2.5-3.1). Immediate eligibility for treatment reduced HIV incidence in households by 47% in our optimal estimate (hazard ratio = 0.53, 95% confidence interval 0.30-0.96), and by 32-60% in alternate specifications of the model. - Conclusion: Immediate eligibility of ART led to substantial reductions in household-level HIV incidence.