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Removing clinic barriers to rapid initiation of ART in Uganda enables 70% to start on the same day
Roger Pebody, 2016-02-25 17:10:00

Making point-of-care CD4 count diagnostics available, revising adherence counselling requirements and giving extra training to healthcare workers can almost quadruple the number of patients who begin antiretroviral therapy on the day that they are eligible, Gideon Amanyire of Makerere University told the Conference on Retroviruses and Opportunistic Infections (CROI 2016) in Boston yesterday. The package of health system reforms was provided to a typical, ‘real world’ group of clinics and was embedded in everyday practice, suggesting that the same intervention could have a similar impact elsewhere.

Recent findings from the START and Temprano trials have shown that starting HIV treatment early, while the CD4 cell count remains above 500 cells/mm3, reduces the occurrence of AIDS-related events, serious non-AIDS-related illness and death. Although the World Health Organization now recommends that everyone diagnosed with HIV should start treatment, most people with HIV in sub-Saharan Africa start treatment too late. Last year a meta-analysis found that Ugandans typically first present to services with a CD4 cell count of 370 cells/mm3 and begin treatment at a CD4 cell count of 119 cells/mm3.