Antiretroviral Therapy, HIV
Conditions
Brief summary
In its 2017 revision of the global guidelines for HIV care and treatment, the World Health Organization (WHO) called for rapid or same-day initiation of antiretroviral treatment (ART) for eligible patients testing positive for HIV. However, to date neither the WHO nor the Zambia Ministry of Health has provided detailed guidance on how to implement this recommendation. In sub-Saharan Africa, where most HIV patients are located, studies continue to document high losses of treatment-eligible patients from care before they receive their first dose of antiretroviral medications (ARVs). Among facility-level reasons for these losses are treatment initiation protocols that require multiple clinic visits and long waiting times before a patient who tests positive for HIV is dispensed an initial supply of medications. There is very little published evidence on the practical details of the process and the extent to which it varies by facility, setting, or country. Without a robust baseline evidence base, it is challenging to identify opportunities for making improvements. The SPRINT (Survey of Procedures and Resources for Initiating Treatment of HIV in Africa) study will begin to develop this evidence base. SPRINT will combine a facility-level description of the standard of care with a retrospective record review of patients who recently initiated ART at the study sites. Data will be collected from 12 health facilities in Zambia. The survey will elicit detailed information about current procedures through structured interviews with clinic staff at the selected health facilities. The record review for a retrospective cohort of patients eligible for ART will estimate actual numbers of clinic visits, services provided, and duration of the steps for treatment initiation from start to finish. SPRINT is expected to identify differences in approaches to treatment initiation and potential opportunities for improvement.
Interventions
The study will collect routine medical record data from the electronic medical record system, other electronic databases, and paper charts.
Clinicians and lay staff will be interviewed regarding the ART initiation process.
Sponsors
Bill and Melinda Gates Foundation
University of Witwatersrand, South Africa
Clinton Health Access Initiative Inc.
Boston University
Study design
Observational model
COHORT
Time perspective
RETROSPECTIVE
Eligibility
Sex/Gender
ALL
Age
18 Years to No maximum
Inclusion criteria
* ≥18 years old * HIV-positive
Exclusion criteria
* Pregnant
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Average numbers of visits required to start ART | Up to 6 months after treatment eligibility determined | Number of health system interactions required between HIV diagnosis and first dispensing of ARVs |
| Time to ART initiation | Up to 6 months after treatment eligibility determined | Average number of days required between HIV diagnosis and first dispensing |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| Proportion of patients who initiate by specified time intervals | Up to 6 months after treatment eligibility determined | Proportion of patients who initiate ART within 0, 7, 14, and 28 days and 3 and 6 months of determination of treatment eligibility |
Other
| Measure | Time frame | Description |
|---|---|---|
| Procedures for ART initiation | Up to 6 months after treatment eligibility determined | Detailed descriptive information addressing such topics as patient flow, number of required clinic visits, intervals between visits, services provided, staffing cadres involved, and record keeping systems |
Countries
South Africa, Zambia
Outcome results
None listed