Department of Global Health, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands.
Amsterdam Institute for Global Health and Development, Amsterdam, The Netherlands.
Trop Med Int Health. 2019 May;24(5):563-570. doi: 10.1111/tmi.13214. Epub 2019 Mar 3.
There are concerns that immediate ART initiation (regardless of CD4 count) negatively affects HIV status disclosure, ART adherence and healthcare interactions. We assessed changes in these factors after the 'Early access to ART for all' intervention, a universal test-and-treat study in Swaziland.
We recruited two samples of participants between 2014 and 2017. The first group was interviewed before the intervention (control); the second group at the implementation and 6 months thereafter (intervention).
High levels of disclosure to partners (controls and intervention: 94%) and family members (controls: 78%, intervention: 79%) were reported, and high levels of adherence (85% did not miss a dose among the controls, 84% in the intervention group). There were no changes in patients reporting feeling pressured to initiate ART (controls: 10%, intervention: 11%). The quality of interaction with healthcare workers improved after the intervention; healthcare workers explained more often the choice of ART initiation (controls: 88%, intervention: 93%) and the meaning of both CD4 and viral load test results (controls: 15%, intervention: 47%). More patients in the intervention group reported receiving test results (controls: 13%, intervention: 46%). We observed no changes in disclosure, adherence or patient experiences 6 months into the intervention compared to its start.
Our results suggest that both reported adherence and disclosure levels remain high after the introduction of immediate ART in Swaziland. We observed an improvement in the healthcare interactions, possibly due to training at participating facilities, which will be an important element for a successful roll-out of immediate ART.
有人担心立即开始抗逆转录病毒治疗（无论 CD4 计数如何）会对 HIV 状况的披露、抗逆转录病毒治疗的依从性和医疗保健互动产生负面影响。我们评估了在斯威士兰开展的“所有艾滋病毒感染者尽早接受抗逆转录病毒治疗”（universal test-and-treat）研究中，这些因素在该干预措施实施前后的变化。
我们在 2014 年至 2017 年间招募了两组参与者。第一组在干预前（对照组）接受访谈；第二组在干预实施时和之后 6 个月接受访谈。
报告了较高的伴侣（对照组和干预组：94%）和家庭成员（对照组：78%，干预组：79%）的 HIV 状况披露率，以及较高的治疗依从性（对照组中 85%的人没有漏服一剂药物，干预组中 84%的人没有漏服）。没有患者报告因压力而开始抗逆转录病毒治疗（对照组：10%，干预组：11%）。干预后，与医疗保健工作者的互动质量有所改善；医疗保健工作者更经常解释开始抗逆转录病毒治疗的选择（对照组：88%，干预组：93%）以及 CD4 和病毒载量检测结果的含义（对照组：15%，干预组：47%）。更多的干预组患者报告收到了检测结果（对照组：13%，干预组：46%）。与干预开始时相比，干预 6 个月后，在披露、依从性或患者体验方面没有变化。
我们的结果表明，在斯威士兰立即开始抗逆转录病毒治疗后，报告的依从性和披露率仍然很高。我们观察到医疗保健互动有所改善，这可能是由于参与机构的培训，这将是成功实施立即开始抗逆转录病毒治疗的重要因素。
