HIV treatment eligibility expansion and timely antiretroviral treatment initiation following enrollment in HIV care: A metaregression analysis of programmatic data from 22 countries.

摘要: Background The effect of antiretroviral treatment (ART) eligibility expansions on patient outcomes, including rates timely ART initiation among those enrolling in care, has not been assessed a large scale. In addition, it is known whether may lead to “crowding out” sicker patients. Methods and findings We examined changes (within 6 months) at the original site HIV care enrollment after 284,740 adult ART-naive patients 171 International Epidemiology Databases Evaluate AIDS (IeDEA) network sites 22 countries where national policies expanding were introduced between 2007 2015. Half included this analysis from Southern Africa, one-third East remainder Asia-Pacific, Central North America, South America regions. The median age contributing was 33.5 years, percentage female these clinics 62.5%. We 6-month cumulative incidence (CI-ART) before major (i.e., expansion treat persons with CD4 ≤ 350 cells/μL [145 countries] 500 [152 15 countries]). Random effects metaregression models used estimate absolute CI-ART each guideline expansion. crude pooled change 4.3 points (95% confidence interval [CI] 2.6 6.1) 350, baseline 53%; 15.9 (pp) CI 14.3 17.4) 500, 57%. largest increases observed newly eligible for (18.2 pp 47.4 500), no or small under prior guidelines (CD4 350: −0.6 pp, 95% −2.0 0.7 pp; 500: 4.9 3.3 6.5 pp). For younger (16–24 years: 21.5 18.9 24.2 Key limitations include lack counterfactual difficulty accounting secular outcome trends, due universal exposure country. Conclusions These underscore potential improve timeliness globally, particularly young adults.