CD4+ T-Cell Count at Antiretroviral Therapy Initiation in the "Treat-All" Era in Rural South Africa: An Interrupted Time Series Analysis.
CD4+ T-Cell Count at Antiretroviral Therapy Initiation in the "Treat-All" Era in Rural South Africa: An Interrupted Time Series Analysis.
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南非农村“治疗”时代的抗逆转录病毒疗法开始时的CD4+ T细胞计数：一个中断的时间序列分析。
DOI：
10.1093/cid/ciab650
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发表时间：
2022-04-28
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--
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南非于2016年9月实施了普遍检测和治疗（UTT），以鼓励更早开始抗逆转录病毒治疗（ART）。因此，我们进行了中断时间序列（ITS）分析，以评估2014年7月至2019年3月期间在南非农村地区17个公共部门初级保健诊所就诊的≥16岁成年人中UTT对ART开始时平均CD4计数的影响。在20599人（69%为女性）中，有74%的人有CD4计数。ART开始时的平均CD4从UTT前1至8个月的317.1个细胞/μL（95%置信区间[CI]， 308.6至325.6）增加到UTT后1至12个月的421.0个细胞/μL (95% CI， 413.0至429.0)，包括立即增加124.2个细胞/μL （95% CI， 102.2至146.1）。然而，平均CD4计数随后在UTT后13至30个月下降到389.5个细胞/μL (95% CI， 381.8至397.1)，但仍高于UTT前的水平。在整个研究中，男性在CD4细胞计数低于女性（-118.2细胞/μL， 95% CI, -125.5至-111.0）时开始ART。尽管UTT在该农村社区开始抗逆转录病毒治疗时立即导致CD4计数增加，但长期效果并不明显。需要作出更多努力，使人类免疫缺陷病毒感染者，特别是男性尽早开始接受抗逆转录病毒治疗。普遍检测和治疗（UTT）在南非农村开始抗逆转录病毒治疗（ART）时立即引起CD4计数的增加，并具有适度的长期影响。男性在CD4细胞计数低于女性时开始抗逆转录病毒治疗。UTT必须与其他干预措施相结合，以维持早期开始抗逆转录病毒治疗。
South Africa implemented universal test and treat (UTT) in September 2016 in an effort to encourage earlier initiation of antiretroviral therapy (ART). We therefore conducted an interrupted time series (ITS) analysis to assess the impact of UTT on mean CD4 count at ART initiation among adults aged ≥16 years attending 17 public sector primary care clinics in rural South Africa, between July 2014 and March 2019. Among 20 599 individuals (69% women), CD4 counts were available for 74%. Mean CD4 at ART initiation increased from 317.1 cells/μL (95% confidence interval [CI], 308.6 to 325.6) 1 to 8 months prior to UTT to 421.0 cells/μL (95% CI, 413.0 to 429.0) 1 to 12 months after UTT, including an immediate increase of 124.2 cells/μL (95% CI, 102.2 to 146.1). However, mean CD4 count subsequently fell to 389.5 cells/μL (95% CI, 381.8 to 397.1) 13 to 30 months after UTT but remained above pre-UTT levels. Men initiated ART at lower CD4 counts than women (–118.2 cells/μL, 95% CI, –125.5 to –111.0) throughout the study. Although UTT led to an immediate increase in CD4 count at ART initiation in this rural community, the long-term effects were modest. More efforts are needed to increase initiation of ART early in those living with human immunodeficiency virus, particularly men. Universal test and treat (UTT) elicited an immediate increase in CD4 count at antiretroviral therapy (ART) initiation in rural South Africa, with modest long-term effects. Men initiated ART at lower CD4 counts than women. UTT must be combined with other interventions to sustain early ART initiation.
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影响因子：
3.7
作者：
Gupta A;Nadkarni G;Yang WT;Chandrasekhar A;Gupte N;Bisson GP;Hosseinipour M;Gummadi N
通讯作者：
Gummadi N
影响因子：
3
作者：
Baisley, K. J.;Seeley, J.;Shahmanesh, M.
通讯作者：
Shahmanesh, M.
影响因子：
3.8
作者：
Druyts, Eric;Dybul, Mark;Mills, Edward J.
通讯作者：
Mills, Edward J.
影响因子：
6
作者：
Khan S;Spiegelman D;Walsh F;Mazibuko S;Pasipamire M;Chai B;Reis R;Mlambo K;Delva W;Khumalo G;Zwane M;Fleming Y;Mafara E;Hettema A;Lejeune C;Chao A;Bärnighausen T;Okello V
通讯作者：
Okello V
影响因子：
5.2
作者：
Etoori, David;Wringe, Alison;Reniers, Georges
通讯作者：
Reniers, Georges