Reference probability and marginal effects of feeling unwell on day before interview (logistic regression, population averaged model).

<p>*Reference case is a female subject age 30–39, 0–30 days on ART.</p>a<p>Indicates p-value ≤0.05 for Wald test that marginal effect equals marginal effect for 271–360 days on ART.</p>b<p>Indicates p-value >0.05 for Wald test that marginal effect equals marginal effect for 271–360 days on ART.</p

Probability of being unable to perform normal activities last week and of employment by time on ART.

<p>Probability of being unable to perform normal activities last week and of employment by time on ART.</p

Study subject recruitment and inclusion for analysis.

<p>Study subject recruitment and inclusion for analysis.</p

Reference probability and marginal effects of experiencing pain or fatigue during the previous week (logistic regression, population averaged model).

<p>*Reference case is a female subject age 30–39, 1–30 days on ART.</p>a<p>Indicates p-value ≤0.05 for Wald test that marginal effect equals marginal effect for 271–360 days on ART.</p>b<p>Indicates p-value >0.05 for Wald test that marginal effect equals marginal effect for 271–360 days on ART.</p

Probability of not feeling well on day prior to interview by time on ART.

<p>Probability of not feeling well on day prior to interview by time on ART.</p

Reference probability and marginal effects of being employed at time of interview (logistic regression, population averaged model).

<p>*Reference case is a female subject age 30–39, 0–30 days on ART.</p>a<p>Indicates p-value ≤0.05 for Wald test that marginal effect equals marginal effect for 271–360 days on ART.</p>b<p>Indicates p-value >0.05 for Wald test that marginal effect equals marginal effect for 271–360 days on ART.</p

Characteristics of cohort at baseline.

<p>Characteristics of cohort at baseline.</p

Probability of experiencing symptoms last week by time on ART.

<p>Probability of experiencing symptoms last week by time on ART.</p

Mean CD4 cell counts of study cohort and clinic population by time on ART.

<p>Mean CD4 cell counts of study cohort and clinic population by time on ART.</p

Initiating Antiretroviral Therapy for HIV at a Patient’s First Clinic Visit: The RapIT Randomized Controlled Trial

<div><p>Background</p><p>High rates of patient attrition from care between HIV testing and antiretroviral therapy (ART) initiation have been documented in sub-Saharan Africa, contributing to persistently low CD4 cell counts at treatment initiation. One reason for this is that starting ART in many countries is a lengthy and burdensome process, imposing long waits and multiple clinic visits on patients. We estimated the effect on uptake of ART and viral suppression of an accelerated initiation algorithm that allowed treatment-eligible patients to be dispensed their first supply of antiretroviral medications on the day of their first HIV-related clinic visit.</p><p>Methods and Findings</p><p>RapIT (Rapid Initiation of Treatment) was an unblinded randomized controlled trial of single-visit ART initiation in two public sector clinics in South Africa, a primary health clinic (PHC) and a hospital-based HIV clinic. Adult (≥18 y old), non-pregnant patients receiving a positive HIV test or first treatment-eligible CD4 count were randomized to standard or rapid initiation. Patients in the rapid-initiation arm of the study (“rapid arm”) received a point-of-care (POC) CD4 count if needed; those who were ART-eligible received a POC tuberculosis (TB) test if symptomatic, POC blood tests, physical exam, education, counseling, and antiretroviral (ARV) dispensing. Patients in the standard-initiation arm of the study (“standard arm”) followed standard clinic procedures (three to five additional clinic visits over 2–4 wk prior to ARV dispensing). Follow up was by record review only. The primary outcome was viral suppression, defined as initiated, retained in care, and suppressed (≤400 copies/ml) within 10 mo of study enrollment. Secondary outcomes included initiation of ART ≤90 d of study enrollment, retention in care, time to ART initiation, patient-level predictors of primary outcomes, prevalence of TB symptoms, and the feasibility and acceptability of the intervention. A survival analysis was conducted comparing attrition from care after ART initiation between the groups among those who initiated within 90 d. Three hundred and seventy-seven patients were enrolled in the study between May 8, 2013 and August 29, 2014 (median CD4 count 210 cells/mm³). In the rapid arm, 119/187 patients (64%) initiated treatment and were virally suppressed at 10 mo, compared to 96/190 (51%) in the standard arm (relative risk [RR] 1.26 [1.05–1.50]). In the rapid arm 182/187 (97%) initiated ART ≤90 d, compared to 136/190 (72%) in the standard arm (RR 1.36, 95% confidence interval [CI], 1.24–1.49). Among 318 patients who did initiate ART within 90 d, the hazard of attrition within the first 10 mo did not differ between the treatment arms (hazard ratio [HR] 1.06; 95% CI 0.61–1.84). The study was limited by the small number of sites and small sample size, and the generalizability of the results to other settings and to non-research conditions is uncertain.</p><p>Conclusions</p><p>Offering single-visit ART initiation to adult patients in South Africa increased uptake of ART by 36% and viral suppression by 26%. This intervention should be considered for adoption in the public sector in Africa.</p><p>Trial Registration</p><p>ClinicalTrials.gov <a href="https://clinicaltrials.gov/ct2/show/NCT01710397" target="_blank">NCT01710397</a>, and <a href="http://www.sanctr.gov.za/" target="_blank">South African National Clinical Trials Register</a> DOH-27-0213-4177.</p></div