Abstract:
Background: Antiretroviral therapy (ART) initiation timing
has undergone changes over time, with updates to
recommendations for same-day ART initiation. The objective
of this study was to compare early treatment outcomes in a
large Nigerian ART center between the pre-"test and treat" and
"test and treat" eras.
Methods: The study was a retrospective cohort analysis of
1782 patients who started ART in the pre-"test and treat" era
(prior to April 1, 2017) and the "test and treat" era (April 1,
2017, to December 31, 2019) at the Jos University Teaching
Hospital (JUTH) ART clinic. Data were extracted from an
electronic medical record system. Multivariable logistic
regression identified predictors of early immunologic and
virologic failure.
Results: Of the participants, 1452 (81.4%) were in the pre-"test
and treat" group, and 330 (18.5%) were in the "test and treat"
group. Patients in the "test and treat" group had a higherproportion of early immunologic failure (58%) compared to the
pre-"test and treat" group (37%). The odds of early
immunologic failure were higher in the "test and treat" era (OR
5.88; 95% CI 3.29-10.52). Patients in the "test and treat" era had
three times greater odds of early virologic failure (OR 3.46;
95% CI 1.70-7.01).
Conclusions: The study found that the "test and treat" strategy
resulted in poorer early immunologic improvement and viral
suppression compared to the era of CD4+ cell count guided
treatment initiation. Additional interventions may be
necessary to improve the effectiveness of the "test and treat"
strategy, particularly in resource-limited settings
