Rapid initiation of antiretroviral therapy for people living with HIV

摘要: Background Despite antiretroviral therapy (ART) being widely available, HIV continues to cause substantial illness and premature death in low‐and‐middle‐income countries. High rates of loss follow‐up after diagnosis can delay people starting ART. Starting ART within seven days (rapid initiation) could reduce follow‐up, improve virological suppression rates, mortality. Objectives To assess the effects interventions for rapid initiation (defined as offering diagnosis) on treatment outcomes mortality living with HIV. We also aimed describe characteristics used included studies. Search methods We searched CENTRAL, Cochrane Database Systematic Reviews, MEDLINE, Embase, four other databases up 14 August 2018. There was no restriction date, language, or publication status. ClinicalTrials.gov World Health Organization (WHO) International Clinical Trials Registry Platform, websites unpublished literature, including conference abstracts. Selection criteria We randomized controlled trials (RCTs) that compared versus standard care Children, adults, adolescents from any setting were eligible inclusion. Data collection analysis Two review authors independently assessed eligibility studies identified search, risk bias extracted data. The primary at 12 months. have presented all using ratios (RR), 95% confidence intervals (CIs). Where appropriate, we pooled results meta‐analysis. certainty evidence GRADE approach. Main results We 18,011 participants review. All carried out low‐ middle‐income countries adults aged 18 years old older. Only one study pregnant women. In studies, intervention offered part a package several cointerventions targeting individuals, health workers system processes delivered alongside facilitate uptake adherence ART. Comparing probably greater viral months (RR 1.18, CI 1.10 1.27; 2719 participants, 4 studies; moderate‐certainty evidence) better 1.09, 1.06 1.12; 3713 evidence), may retention 1.22, 1.11 1.35; 5001 6 low‐certainty evidence). Rapid associated lower estimate, however CIs effect when 0.72, 0.51 1.01; 5451 7 very It is uncertain whether has an modification regimens data are lacking 7.89, 0.76 81.74; 977 2 insufficient draw conclusions occurrence adverse events. Authors' conclusions RCTs include week appear across cascade settings. demonstrating these combined setting‐specific cointerventions. This highlights need pragmatic research identify feasible packages assure seen through complex systems. Plain language summary available English Francais Effects HIV What aim this review? The determine ART) resulted dying virus people's blood than care; well studying start taking continue be engaged months. Key messages Offering (PLWH) increases number initiating PLWH whose been suppressed who still contact healthcare services don't know dying. found changes made achieve outcomes. What studied review? HIV leading worldwide. Although more ever before, there large percentage not treated. One reasons long period between diagnosed proposed way increase started HIV‐related main review? We met inclusion criteria PLWH. initiated detectable their (moderate‐certainty Based evidence, retained care. deaths (very evidence). We if offer diagnosis, how systems operate will made. How date relevant 2018. Authors' conclusions Implications practice Overall, cascade, least short term. Those implementing should consider modifications required delivery ensure effectiveness. Implications research Now implemented widely, researchers what best modes implementation are, adapt resource constraints order support patients accept ART, link remain Pragmatic helps define ‘treatment readiness', explores feasible, defines help specify implement