Regression discontinuity analysis demonstrated varied effect of Treat-All on CD4 testing among Southern African countries
Date
2021-12
Journal Title
Journal ISSN
Volume Title
Publisher
Pergamon Press
Abstract
Objective: To determine whether Treat-All policy impacted laboratory testing practices of antiretroviral therapy (ART) programs in Southern Africa.
Study Design and Setting: We used HIV cohort data from Lesotho, Malawi, Mozambique, South Africa, Zambia and Zimbabwe in a regression discontinuity design to estimate changes in pre-ART CD4 testing and viral load monitoring following national Treat-all adoption that occurred during 2016–2017. This study included more than 230,000 ART-naïve people living with HIV (PLHIV) aged five years or older who started ART within two years of national Treat-All adoption.
Results: We found pre-ART CD4 testing decreased following adoption of Treat-All recommendations in Malawi (−21.4 percentage points (pp), 95% CI: −26.8, −16.0) and in Mozambique (−8.8pp, 95% CI: −14.9, −2.8), but increased in Zambia (+2.7pp, 95% CI: +0.4, +5.1). Treat-All policy had no effect on viral load monitoring, except among females in South Africa (+7.1pp, 95% CI: +1.1, +13.0).
Conclusion: Treat-All policy expanded ART eligibility, but led to reductions in pre-ART CD4 testing in some countries that may weaken advanced HIV disease management. Continued and expanded support of CD4 and viral load laboratory capacity is needed to further improve treatment successes and allow for uniform evaluation of ART implementation across Southern Africa.
Description
CITATION: Zaniewski, E. et al. 2021. Regression discontinuity analysis demonstrated varied effect of Treat-All on CD4 testing among Southern African countries. Journal of Clinical Epidemiology 140(2021):20 pages. doi.10.1016/j.jclinepi.2021.09.001
The original publication is available at: sciencedirect.com
The original publication is available at: sciencedirect.com
Keywords
CD4 antigen -- Africa, Southern, HIV infections -- Africa, Southern, Antiretroviral agents -- Africa, Southern, Diagnosis, Laboratory -- Africa, Southern, Regression discontinuity design, UCTD
Citation
Zaniewski, E. et al. 2021. Regression discontinuity analysis demonstrated varied effect of Treat-All on CD4 testing among Southern African countries. Journal of Clinical Epidemiology 140(2021):20 pages. doi.10.1016/j.jclinepi.2021.09.001