Trends in Prevalence of Advanced HIV Disease at Antiretroviral Therapy Enrollment - 10 Countries, 2004-2015.
Monitoring prevalence of advanced human immunodeficiency virus (HIV) disease (i.e., CD4+ T-cell count <200 cells/μL) among persons starting antiretroviral therapy (ART) is important to understand ART program outcomes, inform HIV prevention strategy, and forecast need for adjunctive therapies.*,†,§ To assess trends in prevalence of advanced disease at ART initiation in 10 high-burden countries during 2004-2015, records of 694,138 ART enrollees aged ≥15 years from 797 ART facilities were analyzed. Availability of national electronic medical record systems allowed up-to-date evaluation of trends in Haiti (2004-2015), Mozambique (2004-2014), and Namibia (2004-2012), where prevalence of advanced disease at ART initiation declined from 75% to 34% (p<0.001), 73% to 37% (p<0.001), and 80% to 41% (p<0.001), respectively. Significant declines in prevalence of advanced disease during 2004-2011 were observed in Nigeria, Swaziland, Uganda, Vietnam, and Zimbabwe. The encouraging declines in prevalence of advanced disease at ART enrollment are likely due to scale-up of testing and treatment services and ART-eligibility guidelines encouraging earlier ART initiation. However, in 2015, approximately a third of new ART patients still initiated ART with advanced HIV disease. To reduce prevalence of advanced disease at ART initiation, adoption of World Health Organization (WHO)-recommended "treat-all" guidelines and strategies to facilitate earlier HIV testing and treatment are needed to reduce HIV-related mortality and HIV incidence.
Auld, AF; Shiraishi, RW; Oboho, I; Ross, C; Bateganya, M; Pelletier, V; Dee, J; Francois, K; Duval, N; Antoine, M; Delcher, C; Desforges, G; Griswold, M; Domercant, JW; Joseph, N; Deyde, V; Desir, Y; Van Onacker, JD; Robin, E; Chun, H; Zulu, I; Pathmanathan, I; Dokubo, EK; Lloyd, S; Pati, R; Kaplan, J; Raizes, E; Spira, T; Mitruka, K; Couto, A; Gudo, ES; Mbofana, F; Briggs, M; Alfredo, C; Xavier, C; Vergara, A; Hamunime, N; Agolory, S; Mutandi, G; Shoopala, NN; Sawadogo, S; Baughman, AL; Bashorun, A; Dalhatu, I; Swaminathan, M; Onotu, D; Odafe, S; Abiri, OO; Debem, HH; Tomlinson, H; Okello, V; Preko, P; Ao, T; Ryan, C; Bicego, G; Ehrenkranz, P; Kamiru, H; Nuwagaba-Biribonwoha, H; Kwesigabo, G; Ramadhani, AA; Ng'wangu, K; Swai, P; Mfaume, M; Gongo, R; Carpenter, D; Mastro, TD; Hamilton, C; Denison, J; Wabwire-Mangen, F; Koole, O; Torpey, K; Williams, SG; Colebunders, R; Kalamya, JN; Namale, A; Adler, MR; Mugisa, B; Gupta, S; Tsui, S; van Praag, E; Nguyen, DB; Lyss, S; Le, Y; Abdul-Quader, AS; Do, NT; Mulenga, M; Hachizovu, S; Mugurungi, O; Barr, BAT; Gonese, E; Mutasa-Apollo, T; Balachandra, S; Behel, S; Bingham, T; Mackellar, D; Lowrance, D; Ellerbrock, TV
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