Treatment Outcome among patients on ART in Southern Tanzania: Does Time of ART initiation Matter?

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Presentation transcript:

Treatment Outcome among patients on ART in Southern Tanzania: Does Time of ART initiation Matter? B. Msongole1, J. Gamaliel1, B.Christian2, M. Mshana3, J. Bisimba4, E.Okechukwu1, M. Njelekela3 1Family Health International (FHI 360), USAID Boresha Afya Southern Zone, Dar es Salaam, Tanzania. 2Management and Development for Health, USAID Boresha Afya, Dar es Salaam, Tanzania. 3Deloitte Consulting Limited, USAID Boresha Afya Southern Zone, Dar es Salaam, Tanzania. 4United States Agency for International Development, Dar es Salaam, Tanzania.

Background HIV prevalence : 4.7% (≥ 15years) Range 11.4% to < 0.1% Tanzania HIV Prevalence (THIS 2016/2017) HIV prevalence : 4.7% (≥ 15years) Range 11.4% to < 0.1% HIV incidence 0.24% 72,000 new cases per year Estimated PLHIV 1.4 m

Background Universal Test and Treat strategy adopted in 2016 ART initiation regardless of CD4 count or clinical stage Rapid ART initiation strategy introduced in 2017 Initiation within 7 days including same day ART initiation Standard of care – minimum two counselling sessions, initiation within 14 days

Rationale Perceived negative patient outcome with same day ART initiation Readiness Adherence Retention Viral Suppression In operational settings - limited information on impact of same day initiation on patient outcome

Methods Retrospective analysis of routine patient data from 5 HIV clinics Patients enrolled between April and September 2017 Age ≥ 15 years Time of ART initiation – within 14 days Compared between patient on same day initiation (SDI) and those initiated under standard of care (SOC) 6 months retention 12 months retention Viral suppression after 1 year of treatment

Results: Summary SDI SOC n(%) 431(39%) 674(61%) Age (yrs) Median 31 36 Range 16-75 15-85 Sex Males 119 250 Females (%) 312(72%) 424(63%)

Results

Results Outcome SDI (n=431) SOC (n=674) 6 Months Retention 91% (95% CI 88% -94% ) 84% (95% CI 81% - 87%, p=0.0002) 12 Months Retention 88% (95% CI 84% - 92% ) 84% (95% CI 79% - 85%, p = 0.019) Viral Suppression 94% (95% CI 89% - 99% ) 95% (95% CI 92% - 99%, p=0.709)

Conclusion Better retention at 6 and 12 months in same day group Viral suppression high in both groups, no significance difference Results support scaling up same day ART initiation to achieve 2nd 90 and eliminate treatment gap caused by unnecessary delays

Acknowledgement Staff, patients & managers of HIV clinics District Health Management Teams USAID Boresha Afya Southern Zone Program