In 2011, the HPTN 052 trial demonstrated that people living with HIV who initiated treatment earlier – also referred to as early access to antiretroviral therapy (ART) for all – were less likely to transmit the virus to partners. Adoption of this approach meant that thousands of additional people would be eligible for treatment. This was in contrast to guidance at the time that only the sickest clients were prioritized for treatment.
Therefore, it became important to understand the impact of offering immediate treatment initiation to all clients to ensure that it truly achieved health improvements and enhanced care.
Eswatini has the highest HIV prevalence in the world, with 27.3 percent of adults living with HIV. From 2014-2017, CHAI, as part of MaxART, a multi-organization consortium led by the Ministry of Health in collaboration with other partners, evaluated the effectiveness of early access to ART for all policy in Eswatini. The policy was adopted nationally in 2016.
The study team found that early ART initiation for all increased both retention in care after 12 months and the combined outcome of retention and viral suppression (Khan et. al. JIAS 2020).
Other important findings from the study include the following:
- Implementing this treat-all policy led to a significant two-fold decrease in time from enrolment in care to ART initiation. (Walsh et al., Curr HIV/AIDS Rep 2020)
- Early ART initiation decreased the progression of HIV disease overall and did not have an adverse impact on clients with severe disease. (Boeke and Khan et al., HIV Med 2021)
- Early ART initiation did not lead to immediate benefits in mortality. (Chao et al., HIV Med 2020)
The latest article about this study was just published in the journal HIV Medicine. The article looks at whether clients were less likely to keep to their appointment schedules under the treat all policy. There were concerns that with more clients now receiving early treatment, clinics would become overcrowded, wait times would increase, and therefore, clients could be less likely to come in for appointments. In addition, with fewer sick clients being placed on treatment, it was possible clients who felt healthy would be less likely to maintain their scheduled appointments. The study team did not find any detrimental impact of early ART initiation for all on appointment adherence.
