HIV Treatment Outcomes Among Patients Initiated on Antiretroviral Therapy Pre and Post-Universal Test and Treat Guidelines in South Africa

Figures & data

Figure 1 Cohort enrolment and follow-up among patients initiating first-line ART in South Africa Pre-UTT vs during UTT.

Figure 2 Cohort selection.

Table 1 Demographic and Clinical Characteristics at Treatment Initiation Among Patients Initiating ART in South Africa Pre-UTT vs During UTT

Variable	Pre-UTT Initiation (n=1267)	UTT Initiation CD4≤500 (n=936)	UTT Initiation CD4>500 (n=207)	Total (n=2410)
	01 December 2014–31 May 2015	01 December 2016–31 May 2017	01 December 2016–31 May 2017
	n (%)	n (%)	n (%)	n (%)
Sex
Female	759 (59.9%)	518 (55.3%)	154 (74.4%)	1431 (59.4%)
Age at ART Initiation (Years)
Median (IQR)	36.8 (31.1–43.6)	36.6 (30.6–43.9)	34.3 (28.1–45.7)	36.6 (30.6–43.9)
18–29	265 (20.9%)	212 (22.6%)	69 (33.3%)	546 (22.7%)
30–44	735 (58.0%)	520 (55.6%)	85 (41.1%)	1340 (55.6%)
45–59	234 (18.5%)	174 (18.6%)	42 (20.3%)	450 (18.7%)
≥60	33 (2.6%)	30 (3.2%)	11 (5.3%)	74 (3.1%)
Antiretroviral Regimen at ART Initiation
TDF+3TC/FTC+EFV	1216 (96.0%)	856 (91.5%)	199 (96.1%)	2271 (94.2%)
ABC+3TC+EFV/NVP	29 (2.3%)	50 (5.3%)	2 (1.0%)	81 (3.4%)
TDF+3TC/FTC+NVP/LPV/r	22 (1.7%)	30 (3.2%)	6 (2.9%)	58 (2.4%)
CD4 Cell Count at ART Initiation (Cells/mm^3)
Median (IQR)	199 (85–325)	189 (69–311)	673 (589–811)	224 (93–369)
0–200	477 (50.2%)	378 (53.1%)	0 (0.0%)	855 (45.7%)
201–350	288 (30.3%)	200 (28.1%)	0 (0.0%)	488 (26.1%)
351–500	186 (19.5%)	134 (18.8%)	0 (0.0%)	320 (17.1%)
>500	0 (0.0%)	0 (0.0%)	207 (100.0%)	207 (11.1%)
Missing	316	224	0	540
Haemoglobin at ART Initiation, g/dL (Anaemia)
Median (IQR)	12.5 (11.0–13.8)	12.0 (10.5–13.5)	13.5 (12.0–14.5)	12.4 (10.9–13.8)
None	425 (39.7%)	198 (33.3%)	87 (60.0%)	710 (39.2%)
Mild	423 (39.5%)	238 (40.0%)	44 (30.3%)	705 (39.0%)
Moderate	167 (15.6%)	106 (17.8%)	6 (4.1%)	279 (15.4%)
Severe	55 (5.1%)	53 (8.9%)	8 (5.5%)	116 (6.4%)
Missing	197	341	62	600
WHO Stage at ART Initiation
I	243 (54.4%)	181 (62.0%)	44 (80.0%)	468 (58.9%)
II	91 (20.4%)	40 (13.7%)	8 (14.5%)	139 (17.5%)
III	68 (15.2%)	24 (8.2%)	3 (5.5%)	95 (12.0%)
IV	45 (10.1%)	47 (16.1%)	0 (0.0%)	92 (11.6%)
Missing	820	644	152	1616
BMI at ART Initiation (Kg/m^2)
Low <18.5	117 (10.6%)	95 (12.1%)	5 (2.6%)	217 (10.4%)
18.5–24.9	596 (54.2%)	411 (52.4%)	83 (42.8%)	1090 (52.5%)
25–29.9	242 (22.0%)	167 (21.3%)	59 (30.4%)	468 (22.5%)
≥30	144 (13.1%)	112 (14.3%)	47 (24.2%)	303 (14.6%)
Missing	168	151	13	332

Abbreviations: UTT, Universal test and treat; IQR, Interquartile range; TDF, Tenofovir; 3TC, Lamivudine; FTC, Emtricitabine; EFV, Efavirenz; ABC, Abacavir; NVP, Nevirapine; LPV/r, Lopinavir; WHO, World Health Organization; BMI, Body Mass Index.

Table 2 Treatment Outcomes at 12 Months on Treatment Among Patients Initiating ART in South Africa Pre-UTT vs During UTT

Variable	Pre-UTT Initiation (n=1267)	UTT Initiation CD4≤500 (n=936)	UTT Initiation CD4>500 (n=207)	Total (n=2410)
	01 December 2014–31 May 2015	01 December 2016–31 May 2017	01 December 2016–31 May 2017
	n (%)	n (%)	n (%)	n (%)
Treatment Outcomes at 12 Months on ART
Alive in care	944 (74.5%)	538 (57.5%)	117 (56.5%)	1599 (66.4%)
Lost to follow-up	131 (10.3%)	164 (17.5%)	33 (15.9%)	328 (13.6%)
Dead	40 (3.2%)	29 (3.1%)	1 (0.5%)	70 (2.9%)
Transferred-out	152 (12.0%)	205 (21.9%)	56 (27.1%)	413 (17.1%)
Viral Load Measurement at 12 Months on ART^a
Yes	505 (53.5%)	297 (55.2%)	50 (42.7%)	852 (53.3%)
No	439 (46.5%)	241 (44.8%)	67 (57.3%)	747 (46.7%)
Virologic suppression at 12 months on ART^b
Suppressed	397 (78.6%)	265 (89.2%)	50 (100.0%)	712 (83.6%)
Unsuppressed	108 (21.4%)	32 (10.8%)	0 (0.0%)	140 (16.4%)

Notes: ^aAmong those alive and in care at 12 months (n=1599); ^bAmong patients with a viral load recorded at 12 months (±3 months).

Abbreviation: UTT, Universal test and treat.

Table 3 Unadjusted and Adjusted Estimates of the Relation Between Pre-UTT Initiation and UTT Initiation on LTFU

Variable	n (%)	LTFU by 12 Months (n=328/2410)
		Crude HR (95% CI)	Adjusted HR (95% CI)^a
UTT Status
Pre-UTT	131/1267 (10.3%)	1.00	1.00
UTT	197/1143 (17.2%)	1.84 (1.48–2.30)	1.51 (1.16–1.98)
Sex
Female	176/1431 (12.3%)	1.00	1.00
Male	152/979 (15.5%)	1.28 (1.03–1.59)	1.48 (1.12–1.96)
Age at ART Initiation (Years)
18–29	97/546 (17.8%)	1.46 (1.13–1.87)	1.49 (1.10–2.01)
30–44	172/1340 (12.8%)	1.00	1.00
44–59	47/450 (10.4%)	0.81 (059–1.12)	0.77 (0.52–1.14)
≥60	12/74 (16.2%)	1.28 (0.72–2.31)	1.29 (0.63–2.66)
CD4 Cell Count at ART Initiation (Cells/mm^3)
0–200	126/855 (14.7%)	1.00	1.00
201–350	67/488 (13.7%)	0.91 (0.67–1.22)	0.98 (0.70–1.38)
>350	88/527 (16.7%)	1.10 (0.84–1.45)	1.10 (0.78–1.54)
Anaemia at ART Initiation
None	88/710 (12.4%)	1.00	1.00
Mild	102/705 (14.5%)	1.22 (0.92–1.62)	1.37 (0.99–1.88)
Moderate	44/279 (15.8%)	1.41 (0.98–2.02)	1.65 (1.10–2.50)
Severe	19/116 (16.4%)	1.62 (0.99–2.66)	1.88 (1.09–3.25)

Notes: ^aModel adjusted for the following variables at ART initiation: UTT status, sex, age, CD4 cell count and anaemia. Schoenfeld residuals (p=0.503; proportionality assumption satisfied).

Abbreviations: LTFU, Lost to follow-up; HR, Hazard ratio; UTT, Universal test and treat.

Table 4 Unadjusted and Adjusted Estimates of the Relation Between Pre-UTT Initiation and UTT Initiation on LTFU Among Patients Initiating Treatment with a CD4 Cell Count ≤500 Copies/mm³

Variable	LTFU by 12 Months (n=711/1662) - CD4 Cell count ≤500 Copies/mm^3
	n (%)	Crude HR (95% CI)	Adjusted HR (95% CI)^a
UTT Status
Pre-UTT	110/951 (11.6%)	1.00	1.00
UTT	138/711 (19.4%)	1.86 (1.45–2.39)	1.59 (1.21–2.10)
Sex
Female	122/930 (13.1%)	1.00	1.00
Male	126/732 (17.2%)	1.32 (1.03–1.69)	1.56 (1.16–2.08)
Age at ART Initiation (Years)
18–29	71/371 (19.1%)	1.43 (1.07–1.91)	1.56 (1.14–2.14)
30–44	133/941 (14.1%)	1.00	1.00
44–59	37/300 (12.3%)	0.86 (0.60–1.23)	0.79 (0.53–1.19)
≥60	7/50 (14.0%)	1.02 (0.48–2.18)	1.17 (0.51–2.68)
CD4 Cell Count at ART Initiation (Cells/mm^3)
≤350	193/1343 (14.4%)	1.00	1.00
350–500	55/319 (17.2%)	1.15 (0.85–1.55)	1.23 (0.87–1.74)
Anaemia at ART Initiation
None	68/519 (13.1%)	1.00	1.00
Mild	84/566 (14.8%)	1.18 (0.86–1.62)	1.26 (0.91–1.74)
Moderate	39/237 (16.5%)	1.39 (0.94–2.06)	1.56 (1.04–2.36)
Severe	15/94 (16.0%)	1.50 (0.86–2.62)	1.68 (0.95–2.99)

Notes: ^aModel adjusted for the following variables at ART initiation: UTT status, sex, age, CD4 cell count and anaemia. Schoenfeld residuals (p=0.529; proportionality assumption satisfied).

Abbreviations: LTFU, Lost to follow-up; HR, Hazard ratio; UTT, Universal test and treat.

Figure 3 Kaplan-Meier survival estimates of lost to follow-up among patients initiating ART in South Africa Pre-UTT vs during UTT (n=2410).

Table 5 Unadjusted and Adjusted Estimates of the Relation Between Pre-UTT Initiation and UTT Initiation on Virologic Suppression at 12 Months (VL≤400 Copies/mL)

Variable	n (%)	Virologic Suppression at 12 Months (n=712/2410)
		Crude RR (95% CI)	Adjusted RR (95% CI)^a
UTT Status
Pre-UTT	397/505 (78.6%)	1.00	1.00
UTT	315/347 (90.8%)	1.15 (1.09–1.22)	1.13 (1.06–1.19)
Sex
Female	434/517 (84.0%)	1.00	1.00
Male	278/335 (83.0%)	0.99 (0.93–1.05)	1.01 (0.95–1.08)
Age at ART Initiation (Years)
18–29	159/190 (83.7%)	1.03 (0.96–1.12)	0.97 (0.90–1.05)
30–44	384/474 (81.0%)	1.00	1.00
44–59	146/165 (88.5%)	1.09 (1.02–1.17)	1.06 (0.99–1.13)
≥60	23/23 (100.0%)	1.23 (1.18–1.29)	1.12 (1.05–1.19)
CD4 Cell Count at ART Initiation (Cells/mm^3)
0–200	247/311 (79.4%)	1.00	1.00
201–350	159/176 (90.3%)	1.14 (1.06–1.23)	1.15 (1.07–1.24)
>350	158/167 (94.6%)	1.19 (1.11–1.27)	1.17 (1.09–1.26)

Note: ^aModel adjusted for the following variables at ART initiation: UTT status, sex, age, and CD4 cell count.

Abbreviations: VL, Viral load; RR, Relative risk; UTT, Universal test and treat.