Preprint
Impact of increasing CD4 count threshold eligibility for antiretroviral therapy initiation on advanced HIV disease and tuberculosis prevalence and incidence in South Africa: an interrupted time series analysis
- Abstract:
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Introduction
We investigated the impact of increasing CD4 count eligibility for antiretroviral-therapy (ART) initiation on advanced HIV and tuberculosis (TB) prevalence and incidence among people living with HIV (PLHIV) in South Africa.
Methods
We conducted an interrupted time series analysis with de-identified data of PLHIV aged ≥15 initiating ART between April-2012 and February-2020 at 65 primary healthcare clinics in KwaZulu-Natal, South Africa. Outcomes included monthly proportions of new ART initiators presenting with advanced HIV (CD4 count <200 cells/µl) and TB disease. We created a cohort of monthly ART initiators without TB and evaluated the cumulative incidence of TB within 12 months follow-up. We used segmented binomial regression models to estimate relative risks (RR) of outcomes, allowing for a step and slope change after expanding the ART initiation CD4 count eligibility from <350 to <500 cells/µl in January- 2015 and following Universal-Test-and-Treat (UTT) implementation in September-2016.
Results
Among 187,544 participants, median age was 32 (27-39), and 125,065 (66.7%) were female. After January-2015, risk of advanced HIV at initiation decreased by 24.5% (RR=0.745, 95%CI 0.690-0.800) and further reduced by 26.2% following UTT implementation (RR=0.738, 95%CI 0.688-0.788). Risk of TB at initiation also decreased by 28.7% after January-2015 (RR=0.713, 95%CI 0.644-0.782) and further decreased by 17.6% after UTT implementation (RR=0.824, 95%CI 0.703-0.945) but remained stable among initiators with advanced HIV. Among the incidence cohort, the risk of new TB decreased by 31.9% (RR=0.681, 95%CI 0.441-0.921) following UTT implementation. Among the incidence cohort with advanced HIV, there was weak evidence of a decrease in risk of new TB (RR=0.755, 95%CI 0.489-1.021), but it gradually decreased per month (slope change per month 9.7%, RR=0.903, 95%CI 0.872-0.934) following UTT implementation.
Conclusions
Our data supports the added benefit of decreased TB co-burden with expanded ART access. Early diagnosis and immediate linkage to care should be prioritised among PLHIV.
- Publication status:
- Published
- Peer review status:
- Not peer reviewed
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(Preview, Version of record, pdf, 1.5MB, Terms of use)
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- Preprint server copy:
- 10.1101/2024.06.21.24309333
Authors
- Funder identifier:
- https://ror.org/0456r8d26
- Grant:
- INV-051067
- Funder identifier:
- https://ror.org/0187kwz08
- Preprint server:
- medRxiv
- Publication date:
- 2024-06-23
- DOI:
- Language:
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English
- Keywords:
- Pubs id:
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2012908
- Local pid:
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pubs:2012908
- Deposit date:
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2026-05-29
- ARK identifier:
Terms of use
- Copyright holder:
- Asare et al.
- Copyright date:
- 2024
- Rights statement:
- The copyright holder for this preprint (which was not certified by peer review) is the author/funder, who has granted medRxiv a license to display the preprint in perpetuity. It is made available under a CC-BY-NC-ND 4.0 International license.
- Notes:
- This is a preprint of Impact of increasing CD4 count threshold eligibility for antiretroviral therapy initiation on advanced HIV disease and tuberculosis prevalence and incidence in South Africa: an interrupted time series analysis.
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