Poorer early treatment outcomes among Human Immunodeficiency Virus -1 infected patients initiating antiretroviral therapy in the “test and treat” era in Nigeria

Abstract

Background: Antiretroviral therapy (ART) initiation timing has undergone changes over time, with updates to recommendations for  same-day ART initiation. The objective  of this study was to compare early treatment outcomes in a  large Nigerian ART center between  the pre-"test and treat" and  "test and treat" eras.

Methods: The study was a retrospective cohort analysis of 1782 patients who started ART in the pre-"test and treat" era  (prior to April 1,  2017) and the "test and treat" era (April 1,  2017, to December 31, 2019) at the Jos University Teaching  Hospital (JUTH) ART clinic. Data  were extracted from an  electronic medical record system. Multivariable logistic regression identified predictors of early immunologic and  virologic failure.

Results: Of the participants, 1452 (81.4%) were in the pre-"test  and treat" group, and 330 (18.5%) were in the "test and treat"  group.  Patients in the "test and treat" group had a higher  proportion of early immunologic failure (58%) compared to the  pre-"test and treat"  group (37%). The odds of early  immunologic failure were higher in the "test and treat" era (OR  5.88; 95% CI 3.29-10.52). Patients in the  "test and treat" era had  three times greater odds of early virologic failure (OR 3.46;  95% CI 1.70-7.01).

Conclusions: The study found that the "test and treat" strategy resulted in poorer early immunologic improvement and viral suppression compared to the era of CD4+ cell count guided treatment initiation. Additional interventions may be necessary to improve the effectiveness of the "test and treat" strategy, particularly in resource-limited settings.