ASPPH logo


Member Research & Reports

Member Research & Reports

BU Finds Expanded HIV Treatment Eligibility Does Not Crowd Out Sickest

In September 2015, the World Health Organization (WHO) revised its antiretroviral therapy (ART) treatment guidelines for HIV, recommending everyone diagnosed should begin ART immediately upon HIV diagnosis, rather than wait for the infection to reach a certain threshold. As resource-limited countries begin adopting the new guidelines, concerns have arisen about whether health systems can handle a large influx of newly eligible patients, and whether sicker, previously eligible patients would be adversely affected.

Now, a new study led by Boston University School of Public Health (BUSPH) researchers shows ART eligibility expansion did not crowd out the sickest patients or reduce quality of care.

Published in Tropical Medicine & International Health, the study looked at a large ART eligibility expansion in South Africa in 2011, which increased the ART-eligible population by 51 percent. Using data on the 13,809 people who presented to the public sector HIV program in Hlabisa sub-district, KwaZulu-Natal, from April 2010 to June 2012, the researchers found expanding eligibility led to a 32 percent increase in patients starting ART per month. However, all patients started ART faster and there was no decline in ART uptake among sicker patients who had been eligible under earlier guidelines.

“These findings are a positive indication that it is possible to expand HIV treatment access without adverse consequences,” says study co-author Dr. Jacob Bor, assistant professor and Peter T. Paul Career Development professor of global health and epidemiology at BUSPH.

Read more about the study.