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HIV diagnosis at home and same-day ART start tied to better outcomes


Key clinical point: A home-based HIV diagnosis and same-day antiretroviral therapy initiation program may improve outcomes in rural areas.

Major finding: 12-month rates of viral suppression were 50.4% for patients started on ART on the day of a home-based diagnosis, vs. 34.3% for those referred to a clinic for ART.

Data source: Randomized, controlled trial with 278 residents of northern Lesotho who tested positive in home-based HIV testing program.

Disclosures: The study was funded by the Swiss National Science Foundation, Stiftung für Infektiologie beider Basel, and the Gottfried und Julia Bangerter-Rhyner Stiftung. Dr. Labhardt reported support from the Stiftung für Infektiologie beider Basel and the Gottfried and Julia Bangerter-Rhyner and travel support to medical conferences from Gilead Sciences Switzerland Sarl. No other author reported disclosures.

Source: Labhardt ND et al. JAMA. 2018 Mar 1. doi: 10.1001/jama.2018.1818.



– Diagnosing HIV infections in the home and starting persons who tested positive on antiretroviral therapy on the same day significantly increased the likelihood that the HIV-positive individuals would show up at a clinic for care within 3 months of diagnosis. It also improved their odds for having viral suppression at 12 months, compared with those who tested positive but were referred to a clinic for starting ART therapy, the standard of care.

Among 278 residents of the southern African nation of Lesotho, 68.8% of those randomized to an intervention in which they were offered same-day, home-based ART initiation and were given a 30-day supply of medication had linked to care by 3 months of follow-up, compared with 43.1% of those who were diagnosed and then referred to a health care facility to be started on ART, reported Niklaus D. Labhardt, MD, from the Swiss Tropical and Public Health Institute in Basel, and his colleagues.

Dr. Niklaus D. Labhardt Neil Osterweil, Frontline Medical News
Dr. Niklaus D. Labhardt
At 12 months, rates of viral suppression were 50.4% in the same-day ART group, compared with 34.3% in the standard-of-care group, he said at the annual Conference on Retroviruses and Opportunistic Infections.

“This easy addition to the current practice of home-based testing has the potential to improve practice sub-Saharan African when it will become part of future guidelines and policies,” he said at a media briefing following his presentation of the data in an oral abstract session.


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