Poorer early treatment outcomes among Human Immunodeficiency Virus -1 infected patients initiating antiretroviral therapy in the “test and treat” era in Nigeria

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