Blog by: Suryakant Tripathi
Initiating antiretroviral therapy (ART) for HIV patients on the day of diagnosis leads to improved health outcomes, results of a clinical trial in South Africa show. The World Health Organisation recommends that people with HIV should start treatment soon after diagnosis. Despite those guidelines, most people with HIV in South Africa, which has world’s largest HIV treatment programme, start ART later than they should, said lead author of the study Sydney Rosen, research professor of global health at Boston University School of Public Health in the US. Once they get to a clinic, the treatment initiation process is long and complicated, Rosen said, with a first visit for an HIV test, a second visit to determine treatment eligibility, and several more visits for a physical exam, adherence education and counseling.
The researchers hypothesised that offering patients a chance to start treatment on the same day as their first clinic visit would improve the proportion of patients who made it through all the steps and were successfully established on ART. The study randomly assigned 377 adult patients at two public clinics in Johannesburg to two groups — one that was offered the chance to start treatment on the same day, using rapid lab tests and accelerated counseling and a physical exam, and the other assigned to standard treatment procedures, usually requiring three to five more clinic visits over a two- to four-week period.
The researchers found that the same-day initiation of antiretroviral therapy led to a higher proportion of people starting treatment and to better health outcomes. The study, published in the journal PLOS Medicine, found that 97 percent of patients in the rapid-initiation group (dubbed the RapIT intervention) had started ART within 90 days, compared to 72 percent receiving standard care. And by 10 months after enrollment, 64 percent of patients in the rapid group had good outcomes, in terms of viral suppression, compared to 51 percent in the standard arm. ‘The RapIT intervention showed clinically meaningful improvements in ART uptake and viral suppression, providing proof of principle that a single-visit treatment approach can have benefits,’ Rosen said.