Change of treatment guidelines and evolution of ART initiation in rural South Africa: data of a large XXXX care and treatment programme.

@entity1 @entity5394 @entity404 @entity645 @entity5395
BACKGROUND: While WHO recommendations are to treat @entity1 earlier and earlier, it will considerably increase the number of @entity645 infected @entity1 eligible for antiretroviral therapy (ART). In South Africa, a country which carries one of the highest @entity645 burden worldwide, very few studies are available on the impact of the ART guidelines on time to ART initiation in both individuals with low @entity404 count and those newly eligible for ART. We thus aimed to describe ART initiation percentages in a large @entity645 programme in rural KwaZulu-Natal, South Africa, according to the temporal changes of national ART eligibility guidelines from 2007 to 2012. METHODS: Adults who accessed the decentralized Hlabisa @entity645 treatment programme in 2007-2012 were included. Three periods following the temporal change of ART eligibility guidelines were defined (Period 1: until April 2010; @entity5394 : April 2010 - July 2011; @entity5395 : from August 2011). Percentages of ART initiation within three months of programme entry were estimated in @entity1 , in @entity1 of childbearing age (<40  years old) and in older @entity1 , and stratifying by @entity404 count. Trend tests and logistic regression models were used to study the effects of change of guidelines on ART initiation percentages. RESULTS: In individuals with @entity404 count  <=200 cells/ L (N   =   5709 @entity1 , N   =   6743 @entity1 <40  years old and N   =   2017 older @entity1 ), percentages of ART initiation did not differ over time (p trend   =   0.25; 0.28; and 0.14, respectively). In individuals with @entity404 count   =   201-350 cells/ L (N   =   2680 @entity1 , N   =   6086 @entity1 <40  years old and N   =   1415 older @entity1 ), percentages of ART initiation significantly increased over time (p trend <0.01 for the three groups): from 6  % in Period 1 to 20  % in @entity5394 to 40  % in @entity5395 in @entity1 of childbearing age, and from 7  % to 8-10  % to 42  % in @entity1 and in older @entity1 . CONCLUSIONS: As temporal changes of guidelines, percentages of ART initiation significantly increased in newly ART eligible @entity1 and did not decrease in individuals with very low @entity404 counts. It will be crucial to continue verifying the evolution of these percentages of ART initiation with future recommendations reaching near-to-universal access to ART, to ensure that individuals most in need of ART receive it.
