Improved retention and outcomes with same-day HIV testing and treatment

July 25, 2017, Public Library of Science

Initiating antiretroviral therapy (ART) on the same day as HIV testing is feasible and leads to improved retention and health outcomes, according to a trial published in PLOS Medicine.

Standard care for patients who positive for HIV in most settings involves multiple visits for counseling and laboratory procedures to prepare patients for ART initiation and determine eligibility, but this process typically takes weeks and can be a barrier to starting treatment. To determine if accelerating this process can improve retention and , Serena Koenig of Brigham and Women's Hospital, USA, Jean William Pape of Weill Medical College of Cornell University, USA, and their colleagues conducted a of same-day ART initiation at the GHESKIO Centers in Port-au-Prince, Haiti.

Adults testing positive for HIV with early stage disease were randomized to either standard care (3 weekly visits with a social worker and physician before starting ART), or same-day ART (starting treatment on the day of HIV diagnosis). They found that 12 months after HIV testing, retention in care was improved (80% of participants in the same-day ART group versus 72% of the standard care group), as was evidence that ART was working (53% versus 44% with viral load <50 copies/ml; 61% versus 52% with viral load <1,000 copies/ml).

The authors note that further study is necessary to determine if this strategy will be effective in settings other than a large urban clinic, and that despite the improvements shown here, both retention and suppression rates will need to improve further to hit UNAIDS 90-90-90 targets and maximize long-term outcomes. Nevertheless, they note that "These results are important given recent WHO 2016 guidelines stating the lack of evidence in support of same-day ART initiation."

In a linked perspective, Elvin Geng of the University of California, San Francisco, USA, notes that this study is "a critical step toward addressing the knowledge gap about how fast to start ART", and discusses the need to develop approaches to support same-day ART start and improve retention and adherence on a larger scale.

Explore further: Same-day HIV treatment improves health outcomes, study finds

More information: Koenig SP, Dorvil N, Dévieux JG, Hedt-Gauthier BL, Riviere C, Faustin M, et al. (2017) Same-day HIV testing with initiation of antiretroviral therapy versus standard care for persons living with HIV: A randomized unblinded trial. PLoS Med 14(7): e1002357. doi.org/10.1371/journal.pmed.1002357

Related Stories

Same-day HIV treatment improves health outcomes, study finds

May 11, 2016
A clinical trial of same-day initiation of antiretroviral therapy (ART) for HIV patients in South Africa led to a higher proportion of people starting treatment and to better health outcomes, according to a new study led ...

Only one-third of HIV-positive patients remain in care before starting treatment

July 19, 2011
In sub-Saharan Africa, only about one third of patients who test positive for HIV but are not yet eligible for antiretroviral treatment remain in care until they become eligible and start treatment. Some patients never return ...

Early antiretroviral therapy for HIV shown cost-effective

September 21, 2011
Researchers at Weill Cornell Medical College and GHESKIO (Groupe Haitien d'Etude du Sarcome de Kaposi et des Infections Opportunistes) have shown that early treatment of HIV not only saves lives but is also cost-effective. ...

Improved survival with enhanced prophylaxis plus ART in HIV

July 20, 2017
(HealthDay)—For patients with advanced HIV who are initiating antiretroviral therapy (ART), enhanced prophylaxis is associated with reduced rates of death at 24 and 48 weeks, according to a study published in the July 20 ...

Financial incentives increased viral suppression in HIV-positive patients in care

June 19, 2017
Gift cards offered as financial incentives helped to increase viral suppression in human immunodeficiency virus (HIV)-positive patients in a community-based clinical trial in New York and Washington, D.C., two communities ...

Point-of-care CD4 testing is economically feasible for HIV care in resource-limited areas

September 16, 2014
A new point-of-care test to measure CD4 T-cells, the prime indicator of HIV disease progression, can expedite the process leading from HIV diagnosis to antiretroviral therapy (ART) and improve clinical outcomes. Now a study ...

Recommended for you

HIV exports viral protein in cellular packages

February 15, 2018
HIV may be able to affect cells it can't directly infect by packaging a key protein within the host's cellular mail and sending it out into the body, according to a new study out of a University of North Carolina Lineberger ...

Can gene therapy be harnessed to fight the AIDS virus?

February 13, 2018
For more than a decade, the strongest AIDS drugs could not fully control Matt Chappell's HIV infection. Now his body controls it by itself, and researchers are trying to perfect the gene editing that made this possible.

Big data methods applied to the fitness landscape of the HIV envelope protein

February 7, 2018
Despite significant advances in medicine, there is still no effective vaccine for the human immunodeficiency virus (HIV), although recent hope has emerged through the discovery of antibodies capable of neutralizing diverse ...

Scientists report big improvements in HIV vaccine production

February 5, 2018
Research on HIV over the past decade has led to many promising ideas for vaccines to prevent infection by the AIDS virus, but very few candidate vaccines have been tested in clinical trials. One reason for this is the technical ...

Microbiome research refines HIV risk for women

January 25, 2018
Drawing from data collected for years by AIDS researchers in six African nations, scientists have pinpointed seven bacterial species whose presence in high concentrations may significantly increase the risk of HIV infection ...

Researchers find latent HIV reservoirs inherently resistant to elimination by CD8+ T-cells

January 22, 2018
The latest "kick-and-kill" research to eliminate the HIV virus uncovered a potential obstacle in finding a cure. A recent study by researchers at the George Washington University (GW) found that latent HIV reservoirs show ...

0 comments

Please sign in to add a comment. Registration is free, and takes less than a minute. Read more

Click here to reset your password.
Sign in to get notified via email when new comments are made.