Treat all policies saw increased access, uptake of antiretroviral treatment among teenagers who had lived with the virus from infancy

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Well into the era of effective treatment for HIV, a question contributed to a lag in access to the life-saving antiretroviral drugs in resource limited countries: If everyone was eligible for the medicine, would those who need it most urgently be crowded out?

Just the opposite, a study tracking data on antiretroviral treatment initiation among nearly 7,000 children aged 10 to 14 in countries adopting “treat all” policies, found. The study, reported in the Journal of Infectious Diseases, examined trends following the adoption of policies making treatment accessible to all pediatric patients diagnosed with HIV, and later policies making treatment available to all people diagnosed with HIV regardless of age or stage of illness. While data on young teenagers with HIV remains limited, the authors note, they can be presumed to have lived with the virus since infancy, having become infected as a result of exposure before or during birth, or breastfeeding. Drawing on data from seven sub-Saharan African countries — Burundi, Democratic Republic of Congo, Rwanda, Kenya, Uganda, Malawi and Zambia — the authors found that while rates of rapid treatment initiation — within 30 days of diagnosis — among those 10 to 14 increased immediately in countries opening treatment eligibility to all children younger than 15, they increased more under policies opening treatment eligibility for everyone living with the virus. Among the only slightly more than half for who data on immune cell, or CD4 counts, were available, the median count was well below the level that would have made them eligible for treatment in any case.

The results add support for the theory that universal treatment policies, with recommendations covering all affected populations are more efficient and easier to put in practice, including in limited resource settings, than policies establishing specific criteria, the authors, led by Olga Tymejczyk, MPH, of City University of New York’s Institute for Implementation Science in Population Health note.

An accompanying commentary notes that while the start of treatment within 30 days of diagnosis is termed “rapid,” the children whose treatment initiations were tracked by the study had been living with the virus for a decade or more. The commentary examines reasons young adolescents with HIV are not reached earlier with critical screening, diagnoses and treatment services, including stigma, consequences of disclosure, and inadequate support services.


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