PEPFAR settings see impacts of testing, clinic size, gender on timely initiation of care

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Science Speaks is in Atlanta, Georgia this week and will be live-blogging from the 20th CROI — Conference on Retroviruses and Opportunistic Infections from Sunday to Wednesday, covering breaking developments from investigators on cure research, new antiretroviral agents, hepatitis, tuberculosis and treatment as prevention.

The following is a guest post by HIVMA executive director Andrea Weddle.

The percentage of patients who do not initiate care until their immune systems are already severely compromised or until they are suffering from HIV-related illnesses is dropping in four countries targeted by the President’s Emergency Plan for AIDS Relief in sub-Saharan Africa, according to findings presented at the 20th Conference on Retroviruses and Opportunistic Infections on Tuesday. The findings, presented by Dr. Susie Hoffman, highlighted factors prompting earlier initiation of care and support scaling up  HIV testing to link people with HIV to care earlier — when they can more fully benefit from HIV treatment.

The PEPFAR-supported study conducted in Tanzania, Kenya, Mozambique, and Rwanda evaluated changes in stage of disease when patients presented to care from 2006 to 2011. The study also examined individual, program and population factors affecting entry into care.

Late entry was defined according to the 2010 World Health Organization (WHO) guidelines as entering into care with an immune cell – or CD4 – count less than or equal to 350 or Stage 3/4 regardless of CD4 count. The percentage of patients entering care late dropped from 68 percent to 55 percent from 2006 to 2011. A statistically significant increase in CD4 count at entry into care was found with the median CD4 counts increasing from 250 in 2006 to 299 in 2011. However, the percentage entering care very late (with CD4 counts below 200) remained stable at around 20 percent.

At the individual level men and non-pregnant women were at greater risk for entering care late. Patients at larger clinics with more than 700 patients had a 20 percent greater risk of entering care late. In communities with widespread availability of HIV testing and HIV education, late entry into care was significantly reduced.

While all of this represents progress, Dr. Hoffman noted that with more than 50 percent of patients still entering care late in these countries, expansion of HIV testing and access to HIV treatment continues to be urgently needed. The study was conducted by the International Center for AIDS Care and Treatment Program (ICAP)–Columbia University with support from PEPFAR.


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