A new study published in PLoS Medicine found that the adoption of the World Health Organization’s 2015 “Treat All” recommendation was followed by large increases in rapid initiation of antiretroviral therapy (ART) in six sub-Saharan African countries.
The study found significant increases in rapid ART initiation immediately after national introduction of Treat All policies in Burundi, Kenya, Malawi and Rwanda, with 12.5 to 34.5 percentage point increases in the percentage of patients who initiated ART within 30 days of enrolling into HIV care. Although no significant change in rapid ART initiation was observed immediately following national adoption of Treat All in Uganda and Zambia, rates of rapid ART initiation in these countries increased significantly in the months following policy introduction. Overall, across the six countries, 81.6 percent of patients enrolling into care following national adoption of Treat All policies initiated treatment within 30 days of enrollment.
Led by Ms. Olga Tymejczyk of the City University of New York Institute for Implementation Science in Population Health (ISPH), the study used a quasi-experimental regression discontinuity design to assess the impact of national Treat All policies, with data from 814,603 patients enrolling into human immunodefiiency care (HIV) care in the six study countries, part of the IeDEA research collaboration. Using real-world patient data, primarily from public sector health facilities, study findings suggest that national adoption of the WHO’s Treat All recommendation has led to appreciable increases in rapid ART initiation.