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Study: Same-day HIV Treatment Leads to Better Results

Study: Same-day HIV Treatment Leads to Better Results
May 12
15:54 2016
A clinical trial conducted by Boston University researchers found that same-day initiation of ART (antiretroviral therapy) for HIV patients in South Africa resulted in better health outcomes and a higher proportion of the population starting treatment.

South Africa has the planet’s largest HIV treatment program. Despite WHO recommendations that HIV patients begin treatment immediately after diagnosis, many victims are forced to wait before receiving ART.

The process for new patients is long and complicated, says lead study author Sydney Rosen. Numerous appointments are required before treatment begins, including a visit for the initial test, for treatment eligibility, for education and counseling, and for a physical exam.

Rosen hypothesized that offering treatment to new patients on their very first visit would significantly increase the number of patients making it through the initiation process and receiving ART.

The study involved nearly 400 patients split randomly into two groups:

• Group 1 had the option to begin treatment on the first visit
• Group 2 was assigned to standard treatment procedures

For Group 1, doctors utilized rapid lab tests and accelerated physical exams and counseling. Group 1 was dubbed “rapid intervention.” Patients in Group 2 were forced to undergo between 3 and 5 additional visits over a period spanning 2 to 4 weeks before starting ART.

The study, published in PLOS Medicine, found that within 90 days:

• 97% of patients in Group 1 had started therapy
• 72% of patients in Group 2 had started therapy

Ten months later, 64% of patients in Group 1 and 51% of patients in Group 2 showed positive outcomes (in terms of viral suppression).

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“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,” explains Rosen. “The patients who likely benefitted the most from it are those who would not otherwise have initiated treatment at all, or who would have waited until they were sick enough to compromise their prognosis.”

Interestingly, the study revealed a higher drop out rate for patients in the rapid intervention group than in the standard group. When you look at the percentage of patients in each group that failed to begin treatment, however, Group 1 still has far better outcomes:

• Group 1 – 3% failed to start treatment
• Group 2 – 28% failed to start treatment

“The rate of post-initiation attrition is a reminder that early retention in care and adherence support, once patients start treatment, remain high priorities for further research and interventions,” concludes Rosen.

Based on the study’s overall results, authors agree that “consideration could be given to accelerating the process of ART initiation in many different settings and for different types of patients.”

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April Kuhlman

April Kuhlman

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