Time to anti-retroviral therapy among people living with HIV enrolled into care in Myanmar: how prepared are we for 'test and treat'?

• Published in: Global health action Vol. 11; no. 1; pp. 1520473 - 10
• Main Authors: Linn, Kyaw Zin, Shewade, Hemant Deepak, Htet, Kyaw Ko Ko, Maung, Thae Maung, Hone, San, Oo, Htun Nyunt
• Format: Journal Article
• Language: English
• Published: United States Taylor & Francis 01.01.2018; Taylor & Francis Ltd; Taylor & Francis Group
• Subjects: Acquired immune deficiency syndrome; Adult; AIDS; Anti-Retroviral Agents - therapeutic use; Antiretroviral drugs; Antiretroviral therapy; ART initiation; Attrition; Cohort analysis; Cohort Studies; Density; Drug therapy; Female; HIV; HIV - drug effects; HIV care cascade; HIV Infections - drug therapy; HIV Infections - epidemiology; Human immunodeficiency virus; Humans; Immune response; Infections; Internet; Male; Medical diagnosis; Myanmar - epidemiology; operational research; Organizational research; Original; Public health; Retention; Retrospective Studies; SORT IT; Time Factors; time to ART; Myanmar; Asia; Myanmar (Burma); HIV care cascade; ART initiation; SORT IT; attrition; time to ART; operational research
• ISSN: 1654-9716; 1654-9880; 1654-9880
• DOI: 10.1080/16549716.2018.1520473

Background: Among people living with HIV (PLHIV) enrolled into care, time to anti-retroviral therapy (ART) has not been studied in Myanmar. To inform progress, we conducted this operational research among treatment-naive PLHIV (≥18 years) enrolled during a period of three years (2014-2016) at Pyin Oo Lwin, Myanmar. Objectives: To determine (i) the time from HIV diagnosis to ART initiation (time to ART) and associated factors and (ii) the association between time to ART and attrition (loss to follow-up and death) from ART care. Methods: This was a retrospective cohort study involving a record review of secondary programme data. The PLHIV were followed up to 5 December 2017 for ART initiation and up to 31 March 2018 (date of censoring) for attrition during ART. Results: Of 543 enrolled, 373 (69%) were found to be eligible and initiated on ART. Of 373, 245 (67%) were initiated within 6 weeks of enrolment. The median enrolment delay (from diagnosis) was 4 (IQR: 1, 14) days and median ART initiation delay (from ART eligibility) was 20 (IQR: 13, 36) days. The median time to ART (excluding the time interval in pre-ART care) was 29 (IQR: 18, 55) days and was significantly long in those with prevalent TB and CD4 count ≥ 500/mm 3 at enrolment. Among 373, the annual incidence density of attrition was 12.8% (0.95 CI: 10.2, 15.7). Attrition was common in first 100 days. Time to ART (after excluding time interval in pre-ART care) was not significantly associated with attrition. Conclusion: The programme appears to be on track to initiate ART as soon as possible in a 'test and treat' scenario (implemented since September 2017) subject to interventions to reduce ART initiation delay.