At least 30% of HIV + people delay starting ARVs – CDC study

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A large study found that at least 30% f HIV positive individuals in nearly a dozen countries – including Nigeria, Namibia, Swaziland, Zimbabwe, Mozambique, Tanzania, Uganda and Zambia – delay starting life-saving drugs, mainly because they are unaware that quick action increases their chances of survival.

VOA News reports that the study spearheaded by the US Centres for Disease Control and Prevention looked at the prevalence of HIV in Haiti, Vietnam, Nigeria, Namibia, Swaziland, Zimbabwe, Mozambique, Tanzania, Uganda and Zambia. Investigators reviewed more than 694,000 treatment records from 2004 to 2015, from nearly 800 clinical facilities, focusing on patients age 15 and older.

HIV expert Andrew Auld, Malawi country director at the CDC, is lead author of the study. He said in the report that in eight of the countries, the percentage of people receiving early treatment increased, in Haiti, Mozambique and Namibia by 40% or more during the time period.

But Auld said treatment is still not reaching a significant portion of HIV positive people. “So some of the key things that still need to be done in these countries to further reduce the prevalence of advanced disease and HIV treatment initiation are to scale up testing strategies and facilitate HIV diagnosis at earlier disease stages, and also treatment policies that mean that patients once they are diagnosed are eligible to start HIV treatment the same day,” he said.

HIV infects and destroys the immune system’s CD-4 T-cells, so the body gradually loses its ability to fight off infections, eventually with lethal consequences in untreated individuals.

The report says UNAIDS has set a 90-90-90 target in dealing with the HIV epidemic. By 2020, it’s hoped that 90% of all people with HIV will know their status, 90% will receive antiretroviral therapy and 90% of those receiving treatment will have viral suppression. Not only does immediate antiretroviral treatment mean avoiding life-threatening complications, Auld said it reduces the risk of transmission.

Auld said the main reason people wait until they are very sick to go for treatment is they are unaware that quick action increases their chances of survival. Men with more advanced cases, according to Auld, point to work demands that keep them from seeking treatment earlier in the course of the disease. For women, childcare and family obligations are often cited. Among infected children, Auld said the problem is access to testing and treatment.

“HIV diagnosis is not a death sentence,” he stressed. “Excellent HIV treatment is available and people can live long, healthy, productive lives if they adhere to the HIV treatment. And it will increase demand for both testing and treatment services.”

Summary
Monitoring prevalence of advanced human immunodeficiency virus (HIV) disease (i.e., CD4+ T-cell count In an analysis of 694,138 adult ART records from 10 countries, the prevalence of advanced disease at ART initiation during 2004–2015 declined in eight countries. In Mozambique (2004–2014), Namibia (2004–2012), and Haiti (2004–2015), prevalence of advanced disease at ART initiation declined from 73% to 37% (p<0.001), 80% to 41% (p<0.001), and 75% to 34% (p<0.001), respectively. In the remaining seven countries with data available for 2004–2011, significant declines in prevalence of advanced disease were observed in Nigeria, Swaziland, Uganda, Vietnam, and Zimbabwe.Declines in the prevalence of advanced disease at ART enrollment over time in most countries are encouraging, but in 2015, approximately a third of new ART patients still initiated ART late. Adoption of World Health Organization–recommended “treat-all” guidelines and strategies to facilitate earlier HIV testing, and treatment are needed. These strategies would help reduce HIV-related mortality and HIV incidence.

Authors
Andrew F Auld; Ray W Shiraishi; Ikwo Oboho; Christine Ross; Moses Bateganya; Valerie Pelletier; Jacob Dee; Kesner Francois; Nirva Duval; Mayer Antoine; Chris Delcher; Gracia Desforges; Mark Griswold; Jean Wysler Domercant; Nadjy Joseph; Varough Deyde; Yrvel Desir; Joelle Deas Van Onacker; Ermane Robin; Helen Chun; Isaac Zulu; Ishani Pathmanathan; E. Kainne Dokubo; Spencer Lloyd; Rituparna Pati; Jonathan Kaplan; Elliot Raizes; Thomas Spira; Kiren Mitruka; Aleny Couto; Eduardo Samo Gudo; Francisco Mbofana; Melissa Briggs; Charity Alfredo; Carla Xavier; Alfredo Vergara; Ndapewa Hamunime; Simon Agolory; Gram Mutandi; Naemi N Shoopala; Souleymane Sawadogo; Andrew L Baughman; Adebobola Bashorun; Ibrahim Dalhatu; Mahesh Swaminathan; Dennis Onotu; Solomon Odafe; Oseni Omomo Abiri; Henry H Debem; Hank Tomlinson; Velephi Okello; Peter Preko; Trong Ao; Caroline Ryan; George Bicego; Peter Ehrenkranz; Harrison Kamiru; Harriet Nuwagaba-Biribonwoha; Gideon Kwesigabo; Angela A. Ramadhani; Kahemele Ng’wangu; Patrick Swai; Mohamed Mfaume; Ramadhani Gongo; Deborah Carpenter; Timothy D Mastro; Carol Hamilton; Julie Denison; Fred Wabwire-Mangen; Olivier Koole; Kwasi Torpey; Seymour G Williams; Robert Colebunders; Julius N Kalamya; Alice Namale; Michelle R Adler; Bridget Mugisa; Sundeep Gupta; Sharon Tsui; Eric van Praag; Duc B Nguyen; Sheryl Lyss; Yen Le; Abu S Abdul-Quader; Nhan T Do; Modest Mulenga; Sebastian Hachizovu; Owen Mugurungi; Beth A Tippett Barr; Elizabeth Gonese; Tsitsi Mutasa-Apollo; Shirish Balachandra; Stephanie Behel; Trista Bingham; Duncan Mackellar; David Lowrance; Tedd V Ellerbrock

VOA News report
Morbidity and Mortality Weekly article summary


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