2. Treatment Outcome among patients on ART in Southern Tanzania: Does Time of ART initiation Matter?
B. Msongole1, J. Gamaliel1, B.Christian2, M. Mshana3, J. Bisimba4, E.Okechukwu1, M. Njelekela3
1Family Health International (FHI 360), USAID Boresha Afya Southern Zone, Dar es Salaam, Tanzania.
2Management and Development for Health, USAID Boresha Afya, Dar es Salaam, Tanzania.
3Deloitte Consulting Limited, USAID Boresha Afya Southern Zone, Dar es Salaam, Tanzania.
4United States Agency for International Development, Dar es Salaam, Tanzania.

3. Background HIV prevalence : 4.7% (≥ 15years) Range 11.4% to < 0.1%
Tanzania HIV Prevalence (THIS 2016/2017)
HIV prevalence : 4.7% (≥ 15years)
Range 11.4% to < 0.1%
HIV incidence 0.24%
72,000 new cases per year
Estimated PLHIV 1.4 m

4. Background Universal Test and Treat strategy adopted in 2016
ART initiation regardless of CD4 count or clinical stage
Rapid ART initiation strategy introduced in 2017
Initiation within 7 days including same day ART initiation
Standard of care – minimum two counselling sessions, initiation within 14 days

5. Rationale
Perceived negative patient outcome with same day ART initiation
Readiness
Adherence
Retention
Viral Suppression
In operational settings - limited information on impact of same day initiation on patient outcome

6. Methods
Retrospective analysis of routine patient data from 5 HIV clinics
Patients enrolled between April and September 2017
Age ≥ 15 years
Time of ART initiation – within 14 days
Compared between patient on same day initiation (SDI) and those initiated under standard of care (SOC)
6 months retention
12 months retention
Viral suppression after 1 year of treatment

7. Results: Summary SDI SOC n(%) 431(39%) 674(61%) Age (yrs) Median 31 36
Range
16-75
15-85
Sex
Males
119
250
Females (%)
312(72%)
424(63%)

8. Results

9. Results Outcome SDI (n=431) SOC (n=674) 6 Months Retention
91% (95% CI 88% -94% )
84% (95% CI 81% - 87%, p=0.0002)
12 Months Retention
88% (95% CI 84% - 92% )
84% (95% CI 79% - 85%, p = 0.019)
Viral Suppression
94% (95% CI 89% - 99% )
95% (95% CI 92% - 99%, p=0.709)

10. Conclusion Better retention at 6 and 12 months in same day group
Viral suppression high in both groups, no significance difference
Results support scaling up same day ART initiation to achieve 2nd 90 and eliminate treatment gap caused by unnecessary delays

11. Acknowledgement Staff, patients & managers of HIV clinics
District Health Management Teams
USAID Boresha Afya Southern Zone Program