TY - JOUR
T1 - Early outcomes after implementation of treat all in Rwanda
T2 - an interrupted time series study
AU - for Central Africa IeDEA
AU - Ross, Jonathan
AU - Sinayobye, Jean d.Amour
AU - Yotebieng, Marcel
AU - Hoover, Donald R.
AU - Shi, Qiuhu
AU - Ribakare, Muhayimpundu
AU - Remera, Eric
AU - Bachhuber, Marcus A.
AU - Murenzi, Gad
AU - Sugira, Vincent
AU - Nash, Denis
AU - Anastos, Kathryn
N1 - Funding Information:
The authors thank the patients at participating sites as well as the clinical staff who collected the data used in this analysis. This work was supported by grants from the U.S. National Institute of Mental Health (K23 MH114752) and the U.S. National Institute of Allergy and Infectious Diseases (U01 AI096299).
Funding Information:
This study was supported by National Institutes of Health. Additional support for this project was provided by the Einstein-Rockefeller-CUNY Center for AIDS Research (P30-AI124414) which is supported by the following NIH Co-Funding and Participating Institutes and Centers: NIAID, NCI, NICHD, NHBL, NIDA, NIMH, NIA, FIC and OAR.
Publisher Copyright:
© 2019 The Authors. Journal of the International AIDS Society published by John Wiley & Sons Ltd on behalf of the International AIDS Society
PY - 2019/4
Y1 - 2019/4
N2 - Introduction: Nearly all countries in sub-Saharan Africa have adopted policies to provide antiretroviral therapy (ART) to all persons living with HIV (Treat All), though HIV care outcomes of these programmes are not well-described. We estimated changes in ART initiation and retention in care following Treat All implementation in Rwanda in July 2016. Methods: We conducted an interrupted time series analysis of adults enrolling in HIV care at ten Rwandan health centres from July 2014 to September 2017. Using segmented linear regression, we assessed changes in levels and trends of 30-day ART initiation and six-month retention in care before and after Treat All implementation. We compared modelled outcomes with counterfactual estimates calculated by extrapolating baseline trends. Modified Poisson regression models identified predictors of outcomes among patients enrolling after Treat All implementation. Results: Among 2885 patients, 1803 (62.5%) enrolled in care before and 1082 (37.5%) after Treat All implementation. Immediately after Treat All implementation, there was a 31.3 percentage point increase in the predicted probability of 30-day ART initiation (95% CI 15.5, 47.2), with a subsequent increase of 1.1 percentage points per month (95% CI 0.1, 2.1). At the end of the study period, 30-day ART initiation was 47.8 percentage points (95% CI 8.1, 87.8) above what would have been expected under the pre-Treat All trend. For six-month retention, neither the immediate change nor monthly trend after Treat All were statistically significant. While 30-day ART initiation and six-month retention were less likely among patients 15 to 24 versus >24 years, the predicted probability of both outcomes increased significantly for younger patients in each month after Treat All implementation. Conclusions: Implementation of Treat All in Rwanda was associated with a substantial increase in timely ART initiation without negatively impacting care retention. These early findings support Treat All as a strategy to help achieve global HIV targets.
AB - Introduction: Nearly all countries in sub-Saharan Africa have adopted policies to provide antiretroviral therapy (ART) to all persons living with HIV (Treat All), though HIV care outcomes of these programmes are not well-described. We estimated changes in ART initiation and retention in care following Treat All implementation in Rwanda in July 2016. Methods: We conducted an interrupted time series analysis of adults enrolling in HIV care at ten Rwandan health centres from July 2014 to September 2017. Using segmented linear regression, we assessed changes in levels and trends of 30-day ART initiation and six-month retention in care before and after Treat All implementation. We compared modelled outcomes with counterfactual estimates calculated by extrapolating baseline trends. Modified Poisson regression models identified predictors of outcomes among patients enrolling after Treat All implementation. Results: Among 2885 patients, 1803 (62.5%) enrolled in care before and 1082 (37.5%) after Treat All implementation. Immediately after Treat All implementation, there was a 31.3 percentage point increase in the predicted probability of 30-day ART initiation (95% CI 15.5, 47.2), with a subsequent increase of 1.1 percentage points per month (95% CI 0.1, 2.1). At the end of the study period, 30-day ART initiation was 47.8 percentage points (95% CI 8.1, 87.8) above what would have been expected under the pre-Treat All trend. For six-month retention, neither the immediate change nor monthly trend after Treat All were statistically significant. While 30-day ART initiation and six-month retention were less likely among patients 15 to 24 versus >24 years, the predicted probability of both outcomes increased significantly for younger patients in each month after Treat All implementation. Conclusions: Implementation of Treat All in Rwanda was associated with a substantial increase in timely ART initiation without negatively impacting care retention. These early findings support Treat All as a strategy to help achieve global HIV targets.
KW - Africa
KW - HIV
KW - Treat All
KW - antiretroviral therapy
KW - retention in care
KW - universal test and treat
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U2 - 10.1002/jia2.25279
DO - 10.1002/jia2.25279
M3 - Article
C2 - 30993854
AN - SCOPUS:85064965465
SN - 1758-2652
VL - 22
JO - Journal of the International AIDS Society
JF - Journal of the International AIDS Society
IS - 4
M1 - e25279
ER -
