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Investigators from the CUNY ISPH conducted a study of long-term HIV care outcomes after national adoption of universal HIV treatment guidelines in a geographically diverse cohort of adult patients with HIV. While these guidelines have been broadly adopted around the world, their long-term outcomes haven’t been examined, with most studies limited to single countries and brief follow-up periods after guideline change.
The team reviewed data from nearly 67,000 patients across 109 clinics in 25 countries where universal treatment guidelines had been adopted, using real-world service delivery data from the International epidemiology Databases to Evaluate AIDS (IeDEA) research consortium. The study found that patients enrolling in care and starting HIV treatment after universal treatment guidelines were adopted were more likely to drop out of the clinic by 2 and 3 years after enrollment and treatment initiation, compared with those who started care before the guidelines.
When it came to monitoring viral loads (VL) — a key part of managing HIV — patients initiating treatment after universal HIV treatment guidelines were adopted were slightly more likely to have VL testing at 12 months but less likely at 36 months, with no change at 24 months after starting antiretroviral therapy (ART). Among patients with viral load testing, viral suppression rates were high and stayed the same regardless of when patients started care.
“These results raise concerns about long-term retention of patients after ART initiation, as well as the capacity of HIV programs to provide essential aspects of HIV care, including annual VL monitoring for timely identification of adherence problems and treatment failure,” says first author and senior research scientist Ellen Brazier. “While the adoption and roll-out of universal treatment guidelines in countries around the world holds great promise, identifying and addressing the factors that cause interruptions in care and effective treatment will be essential for the success of efforts to end the HIV epidemic.”
The findings that patient retention in care at the clinic where ART was initiated decreased after the adoption of universal HIV treatment guidelines and that there has been no improvement in annual VL monitoring among patients retained in care should motivate efforts to identify and address factors associated with attrition among patients enrolling in HIV care, as well as barriers to routine VL testing in the era of universal treatment of all people living with HIV.
