Department of Epidemiology and Public Health, University of Maryland, Baltimore, Maryland, United States of America.
Institute of Human Virology, University of Maryland School of Medicine, Baltimore, Maryland, United States of America.
PLoS One. 2019 Jul 10;14(7):e0218555. doi: 10.1371/journal.pone.0218555. eCollection 2019.
In December 2016, the Nigerian Federal Ministry of Health updated its HIV guidelines to a Treat All approach, expanding antiretroviral therapy (ART) eligibility to all individuals with HIV infection, regardless of CD4+ cell count, and recommending ART be initiated within two weeks of HIV diagnosis (i.e., the Test and Treat strategy). The Test and Treat policy was first piloted in 32 local government areas (LGAs). The primary objective of this study was to evaluate the clinical outcomes of adult patients initiated on ART within two weeks of HIV diagnosis during this pilot. We conducted a retrospective cohort analysis of patients who initiated ART within two weeks of new HIV diagnosis between October 2015 and September 2016 in eight randomly selected LGAs participating in the Test and Treat pilot study. 2,652 adults were newly diagnosed and initiated on ART within two weeks of HIV diagnosis. Of these patients, 8% had documentation of a 12-month viral load measurement, and 13% had documentation of a six-month viral load measurement. Among Test and Treat patients with a documented viral load, 79% were suppressed (≤400 copies/ml) at six months and 78% were suppressed at 12 months. By 12 months post-ART initiation, 34% of the patients who initiated ART under the Test and Treat strategy were lost to follow-up. The median CD4 cell count among patients initiating ART within two weeks of HIV diagnosis was 323 cells/mm3 (interquartile range, 161-518). While randomized controlled trials have demonstrated that Test and Treat strategies can improve patient retention and increase viral suppression compared to standard of care, these findings indicate that the effectiveness of Test and Treat in some settings may be far lower than the efficacy demonstrated in randomized controlled trials. Significant attention to the way Test and Treat strategies are implemented, monitored, and improved particularly related to early retention, can help expand access to ART for all patients.
2016 年 12 月，尼日利亚联邦卫生部更新了其艾滋病毒指南，采用了“治疗所有”方法，将抗逆转录病毒疗法（ART）的资格扩大到所有艾滋病毒感染者，无论 CD4+细胞计数如何，并建议在艾滋病毒诊断后两周内开始 ART（即“检测和治疗”策略）。该检测和治疗政策首先在 32 个地方政府区（LGA）试行。本研究的主要目的是评估在此试点期间，在艾滋病毒诊断后两周内开始接受 ART 的成年患者的临床结局。我们对 2015 年 10 月至 2016 年 9 月在参与检测和治疗试点研究的 8 个随机选择的 LGA 中，在新诊断为 HIV 后两周内开始接受 ART 的患者进行了回顾性队列分析。有 2652 名成年人在新诊断为 HIV 后两周内开始接受 ART。这些患者中，8%有 12 个月病毒载量测量记录，13%有 6 个月病毒载量测量记录。在有记录的病毒载量的检测和治疗患者中，79%在 6 个月时被抑制（≤400 拷贝/ml），78%在 12 个月时被抑制。在开始接受 ART 后 12 个月，34%的检测和治疗策略下开始接受 ART 的患者失访。在新诊断为 HIV 后两周内开始接受 ART 的患者的中位 CD4 细胞计数为 323 个细胞/mm3（四分位距，161-518）。虽然随机对照试验表明，与标准护理相比，检测和治疗策略可以提高患者保留率并增加病毒抑制率，但这些发现表明，在某些情况下，检测和治疗的有效性可能远低于随机对照试验中显示的疗效。需要特别关注检测和治疗策略的实施、监测和改进方式，特别是与早期保留相关的问题，这有助于为所有患者扩大获得 ART 的机会。
