Table 3.
ART initiation practices and viral load testing capacity at 187 IeDEA sites implementing Treat All
| Counseling sessions prior to ART initiation | Timing of ART initiation | Viral loada testing routinely available N (%) | |||||
|---|---|---|---|---|---|---|---|
| 0 sessions N (%) | 1 to 2 sessions N (%) | ≥3 sessions N (%) | Same day start N (%) | 1 to 14 days N (%) | 2 to 4 weeks or >1 month N (%) | ||
| All sites | 19 (10.2%) | 123 (65.8%) | 45 (24.1%) | 73 (39%) | 71 (38%) | 43 (23.0%) | 129 (69%) |
| IeDEA region | [p < 0.0001] | ||||||
| Asia‐Pacific | 3 (8.3%) | 27 (75%) | 6 (16.7%) | 3 (8.3%) | 19 (52.8%) | 14 (38.9%) | 33 (91.7%) |
| Caribbean, Central and South America | 0 (0%) | 14 (100%) | 0 (0%) | 5 (35.7%) | 4 (28.6%) | 5 (35.7%) | 12 (85.7%) |
| Central Africa | 0 (0%) | 8 (47.1%) | 9 (52.9%) | 4 (23.5%) | 13 (76.5%) | 0 (0%) | 5 (29.4%) |
| East Africa | 0 (0%) | 19 (45.2%) | 23 (54.8%) | 26 (61.9%) | 16 (38.1%) | 0 (0%) | 23 (54.8%) |
| North America | 15 (38.5%) | 22 (56.4%) | 2 (5.1%) | 11 (28.2%) | 10 (25.6%) | 18 (46.2%) | 38 (97.4%) |
| Southern Africa | 1 (2.9%) | 28 (82.4%) | 5 (14.7%) | 21 (61.8%) | 8 (23.5%) | 5 (14.7%) | 15 (44.1%) |
| West Africa | 0 (0%) | 5 (100%) | 0 (0%) | 3 (60%) | 1 (20%) | 1 (20%) | 3 (60.0%) |
| Health facility type | [p = 0.006] | [p = 0.036] | [p < 0.0001] | ||||
| Primary (health center) | 12 (12.4%) | 61 (62.9%) | 24 (24.7%) | 39 (40.2%) | 39 (40.2%) | 19 (19.6%) | 55 (56.7%) |
| District hospital | 0 (0%) | 7 (41.2%) | 10 (58.8%) | 12 (70.6%) | 3 (17.6%) | 2 (11.8%) | 11 (64.7%) |
| Regional/provincial or teaching hospital | 7 (9.6%) | 55 (75.3%) | 11 (15.1%) | 22 (30.1%) | 29 (39.7%) | 22 (30.1%) | 63 (86.3%) |
| Sector | [p = 0.001] | [p = 0.019] | [p = 0.142] | ||||
| Public | 10 (6.4%) | 104 (66.7%) | 42 (26.9%) | 66 (42.3%) | 60 (38.5%) | 30 (19.2%) | 104 (66.7%) |
| Private | 9 (29%) | 19 (61.3%) | 3 (9.7%) | 7 (22.6%) | 11 (35.5%) | 13 (41.9%) | 25 (80.6%) |
| Facility location | [p = 0.033] | [p < 0.0001] | [p < 0.0001] | ||||
| Urban/mostly urban | 18 (13.2%) | 89 (65.4%) | 29 (21.3%) | 40 (29.4%) | 54 (39.7%) | 42 (30.9%) | 110 (80.9%) |
| Rural/mostly rural | 1 (2%) | 34 (66.7%) | 16 (31.4%) | 33 (64.7%) | 17 (33.3%) | 1 (2%) | 19 (37.3%) |
| Country income group | [p < 0.0001] | [p < 0.0001] | [p < 0.0001] | ||||
| Low income | 1 (1.9%) | 39 (72.2%) | 14 (25.9%) | 23 (42.6%) | 28 (51.9%) | 3 (5.6%) | 21 (38.9%) |
| Lower‐middle income | 0 (0%) | 20 (45.5%) | 24 (54.5%) | 31 (70.5%) | 13 (29.5%) | 0 (0%) | 23 (52.3%) |
| Upper‐middle income | 1 (3.6%) | 24 (85.7%) | 3 (10.7%) | 5 (17.9%) | 13 (46.4%) | 10 (35.7%) | 26 (92.9%) |
| High income | 17 (27.9%) | 40 (65.6%) | 4 (6.6%) | 14 (23%) | 17 (27.9%) | 30 (49.2%) | 59 (96.7%) |
| PEPFAR‐supported country | [p < 0.0001] | [p < 0.0001] | [p < 0.0001] | ||||
| No | 18 (21.4%) | 61 (72.6%) | 5 (6%) | 18 (21.4%) | 28 (33.3%) | 38 (45.2%) | 80 (95.2%) |
| Yes | 1 (1%) | 62 (60.2%) | 40 (38.8%) | 55 (53.4%) | 43 (41.8%) | 5 (4.9%) | 49 (47.6%) |
| GFATM‐supported country | [p < 0.0001] | [p < 0.0001] | [p < 0.0001] | ||||
| No | 17 (23.6%) | 51 (70.8%) | 4 (5.6%) | 17 (23.6%) | 21 (29.2%) | 34 (47.2%) | 70 (97.2%) |
| Yes | 2 (1.7%) | 72 (62.6%) | 41 (35.7%) | 56 (48.7%) | 50 (43.5%) | 9 (7.8%) | 59 (51.3%) |
| Year of national Treat All adoption | [p < 0.0001] | ||||||
| 2012 (2 countries) | 15 (38.5%) | 22 (56.4%) | 2 (5.1%) | 11 (28.2%) | 10 (25.6%) | 18 (46.2%) | 38 (97.4%) |
| 2013 (2 countries) | 0 (0%) | 8 (100%) | 0 (0%) | 3 (37.5%) | 2 (25.0%) | 3 (37.5%) | 8 (100%) |
| 2014 (2 countries) | 1 (16.7%) | 4 (66.7%) | 1 (16.7%) | 0 (0%) | 4 (66.7%) | 2 (33.3%) | 6 (100%) |
| 2015 (2 countries) | 2 (12.5%) | 14 (87.5%) | 0 (0%) | 1 (6.3%) | 6 (37.5%) | 9 (56.3%) | 15 (93.8%) |
| 2016 (16 countries) | 1 (1.0%) | 57 (59.4%) | 38 (39.6%) | 52 (54.2%) | 38 (39.6%) | 6 (6.3%) | 45 (46.9%) |
| 2017 (2 countries) | 0 (0%) | 3 (75.0%) | 1 (25.0%) | 1 (25.0%) | 2 (50.0%) | 1 (25.0%) | 4 (100%) |
| Treat All not adopted nationallyb (15 countries) | 0 (0%) | 15 (83.3%) | 3 (16.7%) | 5 (27.8%) | 9 (50.0%) | 4 (22.2%) | 13 (72.2%) |
| Timing of national Treat All adoptionc | [p < 0.0001] | [p < 0.0001] | [p < 0.0001] | ||||
| Before WHO recommendation | 18 (26.1%) | 48 (69.6%) | 3 (4.3%) | 15 (21.7%) | 22 (31.9%) | 32 (46.4%) | 67 (97.1%) |
| After WHO recommendation | 1 (1%) | 62 (60.2%) | 40 (38.8%) | 53 (53.0%) | 40 (40.0%) | 7 (7.0%) | 49 (49.0%) |
| Treat All not adopted nationally | 0 (0%) | 13 (86.7%) | 2 (13.3%) | 5 (27.8%) | 9 (50.0%) | 4 (22.2%) | 13 (72.2%) |
aQuantitative PCR or viral load assay available for routine use; bsites in countries that adopted Treat All in 2017 after the survey was completed counted among sites where Treat All was not yet adopted nationally; ctiming relative to WHO recommendation of September 2015.