Nov 12, 2018; Journal of Acquired Immune Deficiency Syndromes. https://insights.ovid.com/crossref?an=00126334-900000000-96516
Background: In 2012, Rwanda introduced a Treat All approach for HIV-infected children under age 5. We compared antiretroviral therapy (ART) initiation, outcomes, and retention, before and after this change.
Methods: We conducted a retrospective study of children enrolled into care between June 2009-December 2011 (Before Treat All cohort [BTA]) and between July 2012-April 2015 (Treat All cohort [TA]).
Setting: Medical records of a nationally representative sample were abstracted for all eligible aged 18-60 months from 100 Rwandan public health facilities.
Results: We abstracted 374 medical records: 227 in the BTA and 147 in the TA cohorts. Mean (SD) age at enrollment was (3 years [1.1]). Among BTA, 59% initiated ART within one year, vs. 89% in the TA cohort. Median time to ART initiation was 68 days (IQR 14-494) for BTA and 9 days (IQR 0-28) for TA (p<0.0001), with 9 (5%) undergoing same-day initiation in BTA compared to 50 (37%) in TA (p < 0.0001).
Before ART initiation, 59% in the BTA reported at least one health condition compared to 35% in the TA cohort (p < 0.0001).
While overall loss to follow-up (LTFU) was similar between cohorts (BTA: 13%, TA: 8%, p = 0.18), LTFU prior to ART was significantly higher in the BTA (8%) compared to the TA cohort (2%) (p = 0.02).
Conclusions: Nearly 90% of Rwandan children started on ART within one year of enrollment; most within 1 month, with greater than 90% retention following implementation of TA. TA was also associated with fewer morbidities.