Interventions to reduce mortality in sub-Saharan Africa among HIV-infected adults not yet on antiretroviral therapy

Abstract

Where antiretroviral therapy is available, the primary source of mortality among HIV-infected people is the delay in starting treatment. Many of these delays occur in the context of care and are modifiable through changes in the protocols followed by healthcare providers for HIV testing, staging and preparation of patients for antiretroviral therapy. A number of potential evidence-based interventions are discussed in the context of sub-Saharan Africa. Included are decentralizing services, initiating counseling on antiretroviral therapy without delay, tracing patients that miss appointments, protecting patient confidentiality, reducing user fees, and providing point-of-care tests for CD4 cell counts, cryptococcal antigen, and for the diagnosis of TB.

Keywords::

• adherence
• antiretroviral therapy
• clinical staging
• counseling
• HIV
• HIV testing
• lost to follow-up
• mortality
• opportunistic infection
• sub-Saharan Africa

Acknowledgements

The authors wish to express thanks to Bouke de Jong, Robert Lukande and Lut Lynen for their conceptual contributions to the article. K Peterson is supported by ITG Secondary Research Funding (SOFI-A), Institute of Tropical Medicine, Belgium. D Huis in ‘t Veld is supported by a PhD fellowship of the Research Foundation – Flanders (FWO), Belgium.

Financial & competing interests disclosure

The authors have no relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript. This includes employment, consultancies, honoraria, stock ownership or options, expert testimony, grants or patents received or pending, or royalties.

No writing assistance was utilized in the production of this manuscript.

Notes

ART: Antiretroviral treatment.

ART: Antiretroviral treatment; OI: Opportunistic infection.

ART: Antiretroviral treatment; CrAg: Cryptococcal antigen; OI: Opportunistic infection; TMP–SMX: Trimethoprim–sulfamethoxazole.