Starting antiretroviral treatment earlier doesn’t negatively impact adherence and disclosure

People who start antiretroviral treatment early, regardless of their CD4 count, are just as likely to stick to their treatment plan as those who begin their treatment when their CD4 count is low.

The mixed methods paper led by the Amsterdam Institute for Global Health and Development and published in Tropical Medicine & International Health, looked at adherence and disclosure of people following the WHO guideline of antiretroviral treatment (ART) for all HIV positive individuals compared to the approach of starting treatment when the CD4 count is below a certain level. The paper is the latest produced by the successful MaxART consortium in which AIGHD and UvA participate.

The universal test and treat approach involves initiating treatment to all HIV positive individuals regardless of CD4 count or disease stage. It is aimed at eliminating HIV by putting more people on ART, to ensure more people maintain an undetectable viral load and ultimately, reduce the spread of the virus.

The study included two groups: the control group who started ART according to the national guidelines of Swaziland, which meant their CD4 count decreased to below 350 cells/mm³ before they began treatment. The intervention group began ART regardless of CD4 count.

The findings showed that those who began treatment early were just as adherent as the group who began treatment when their CD4 counts decreased to a certain level. It was previously thought those who began ART immediately may not be as committed to their treatment regimen as they likely would not have begun experiencing symptoms of HIV and therefore not felt the need to continue the treatment. The study also showed that the same high levels of disclosure are found in the early ART group as in the control group. Disclosing one’s HIV-status is crucial for organizing care and support but might have detrimental effects on social relationships.

“Another positive conclusion was that the interaction with health care staff improved because they spent more time explaining things to patients, for example what the tests they were conducting meant and shared their results with them,” said Marjan Molemans, lead author on the study and junior researcher with AIGHD.

“For countries who are hesitant to roll out these new guidelines, we hope this provides them with reassurance that beginning treatment earlier does not negatively impact adherence or disclosure.”

The multidisciplinary team also included epidemiologist Frank van Leth (ass. Prof AIGHD), medical anthropologist Ria Reis (AIGHD & UvA), PhD candidate and project coordinator Eva Vernooij (UvA), former AIGHD researcher Gabriela Gomez and a research team in Swaziland.

The first study for AIGHD junior researcher

For Marjan, the work was particularly notable because it was her first published study.

“For me, I learned a lot about real-life data analysis and the challenges that come with it, for example, cleaning the data took quite a long time,” she said, adding the mentorship she received from her more senior colleagues was invaluable.

“It was also really interesting to collaborate with other disciplines because there were certain things we needed more context on and the anthropologists were able to use their qualitative expertise to interpret some of the findings.”

Read the full publication here.

Photo caption: AIGHD junior researcher Marjan Molemans and assoc. prof.  Frank van Leth