Evaluation of the implementation of Early ART strategy in clinics for HIV services in Santo Domingo, Dominican Republic

Abstract

Introduction: Prioritization of strategies aiming to reduce the timing between HIV diagnosis and Antiretroviral Therapy (ARV) reduced clinical events for HIV infected clients and reduces sexual transmission rates. Based on these benefits, Early ARV initiation shows clinical and public health benefits. The aim of this study was to evaluate the implementation of an early ARV dispensing strategy in an HIV Clinic in the Dominican Republic.

Materials and Methods: Clinical data was collected from all patients seeking HIV services between the moths of April-September 2019. Only data from patient with a new HIV diagnosis were analysed. All patients were offered ARV according to national guidelines statutes. We studied the timeframe between HIV+ diagnosis and ARV start and risk factors that seemed to contribute to early or delayed ARV initiation.

Results: A total of 64 new HIV diagnosis and enrolment were made in the study period. Of the studied populations 51% (n=33) were offered ARV in the first 7 days of receiving an HIV diagnosis, while 20% (n=13) waited between 8-14 days to start ARV and 28% (n=18) started ARV after 15 days of their diagnosis. Patients with unidentified risk for HIV infection were associated with early ARV, especially within the first 7 days (p<0.01). Transactional Sexual Work and Intravenous Drug Use were independently associated with delayed ARV start within the studied period (p<0.001). Differences in mean viral load and CD4+cell count were not associated with the ARV initiation period. Adherence rate of >85% within the first 3 months of ARV use was associated with early ARV start within 1-7 days (p=0.05), no difference can be distinguished after the 7th day of delayed ARV start (p=0.2).

Conclusions: To achieve the second 90 in the HIV care continuum, we have to understand the factors contributing to the increasing gap. Demographic characteristics of patients seeking HIV and ARV services seem to contribute to the likelihood of initiating ARV within an optimal timeframe. Targeted efforts to decrease such barriers should be addressed especially in hard to reach population such as transactional sexual workers and intravenous drug users. Services optimizing early ARV start seem to indicate increased adherence rates within the first months of ARV use, showing a benefit to public health beside individual users.