Regression discontinuity analysis demonstrated varied effect of Treat-All on CD4 testing among Southern African countries

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dc.contributor.authorZaniewski, Elizabethen_ZA
dc.contributor.authorBrazier, Ellenen_Za
dc.contributor.authorOstinelli, Cam Ha Daoen_ZA
dc.contributor.authorWood, Robinen_ZA
dc.contributor.authorOsler, Megen_ZA
dc.contributor.authorTechnau, Karl-Günteren_ZA
dc.contributor.authorVan Oosterhout, Joep Jen_ZA
dc.contributor.authorMaxwell, Nicolaen_ZA
dc.contributor.authorVan Dijk, Jannekeen_ZA
dc.contributor.authorProzesky, Hansen_ZA
dc.contributor.authorFox, Matthew Pen_ZA
dc.contributor.authorBor, Jacoben_ZA
dc.contributor.authorNash, Denisen_ZA
dc.contributor.authorEgger, Matthiasen_ZA
dc.date.accessioned2023-03-28T06:16:37Zen_ZA
dc.date.available2023-03-28T06:16:37Zen_ZA
dc.date.issued2021-12en_ZA
dc.descriptionCITATION: 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.2021.09.001en_ZA
dc.descriptionThe original publication is available at: sciencedirect.comen_ZA
dc.description.abstractObjective: 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.en_ZA
dc.description.versionPublisher’s versionen_ZA
dc.format.extent20 pagesen_ZA
dc.identifier.citationZaniewski, 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.2021.09.001en_ZA
dc.identifier.issn0895-4356 (print)en_ZA
dc.identifier.issn1878-5921 (online)en_ZA
dc.identifier.urihttp://hdl.handle.net/10019.1/126720en_ZA
dc.language.isoen_ZAen_ZA
dc.publisherPergamon Pressen_ZA
dc.rights.holderAuthors retain copyrighten_ZA
dc.subjectCD4 antigen -- Africa, Southernen_ZA
dc.subjectHIV infections -- Africa, Southernen_ZA
dc.subjectAntiretroviral agents -- Africa, Southernen_ZA
dc.subjectDiagnosis, Laboratory -- Africa, Southernen_ZA
dc.subjectRegression discontinuity designen_ZA
dc.subjectUCTDen_ZA
dc.titleRegression discontinuity analysis demonstrated varied effect of Treat-All on CD4 testing among Southern African countriesen_ZA
dc.typeArticleen_ZA
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