Koenig, S.P., Dorvil, N., Devieux, J.G., et al. PLOS Medicine (July 2017), 14(7), doi: e1002357.
This randomized controlled trial examined whether same-day testing and antiretroviral therapy (ART) initiation, versus the standard of care, improved retention and virologic suppression among 762 outpatients in Haiti. Standard of care participants received care that followed national guidelines, including ART initiation on day 21 following a positive HIV test, in addition to other laboratory and social work visits that took place before initiation. The control and study groups received the same number of visits; the schedule of visits, including day of initiation, was the only difference between the two study arms. All participants had monthly visits and were followed for 12 months. In the standard group, 72 percent were retained, 6 percent died, and 23 percent were lost to follow-up (LTFU). Among retained patients in the standard care group, 61 percent had a viral load <50 copies/mL. In the study group, 80 percent were retained, 3 percent died, and 17 percent were LTFU. Among those retained in the study group, 66 percent had a viral load <50 copies/mL. In comparison to the standard of care, same-day treatment initiation resulted in improved retention, increased viral suppression, and decreased mortality. The authors concluded that same-day ART initiation can be effectively implemented in resource-poor settings, and does not require additional resources.