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Title
Fast-track ART initiation in Botswana is associated with high rates of ART initiation, retention in care, and virological suppression
Presenter
Refeletswe Lebelonyane
Authors
R. Lebelonyane1, P. Bachanas2, W. Abrams3, M. Roland3, J. Theu1, M. Kapanda1, S. Matambo3, S. Lockman4, J. Moore2, L. Block5, T. Gaolathe6, J. Makhema6, J.N. Jarvis6,7
Institutions
1Botswana Ministry of Health and Wellness, Gaborone, Botswana, 2Centers for Disease Control and Prevention, Division of Global HIV/AIDS and TB, Atlanta, United States, 3Centers for Disease Control and Prevention, Gaborone, Botswana, 4Harvard T.H. Chan School of Public Health, Boston, United States, 5Intellectual Concepts, Atlanta, United States, 6Botswana Harvard Partnership, Gaborone, Botswana, 7Botswana-UPenn Partnership, Gaborone, Botswana

Background: The Botswana Combination Prevention Project (BCPP) started in 2013 and has offered “fast-track” ART initiation at the first clinic visit since June 2016. We examined treatment outcomes pre- and post- fast-track ART initiation.
Methods: BCPP is a cluster-randomized trial evaluating a combination HIV prevention package in 15 intervention and 15 control communities. In the intervention communities, we compared the cumulative proportion of individuals initiating ART (using Kaplan Meier estimates), as well as retention in care and viral suppression in patients, comparing outcomes in two periods: following the introduction of fast-track ART (June 2016-November 2017), versus pre- fast track ART initiation (October 2013-May 2016).
Results: Overall 3622 HIV-infected individuals not on ART were identified through community testing activities and referred for treatment, and 3315 (92%) linked to care. At data censoring in November 2017, 91% (2682/2943) of linked, eligible individuals had initiated ART. The cumulative probability of initiating ART within one year of linkage was 84% and 87% in pre- and post-fast track groups respectively. ART initiations occurred more quickly after implementation of fast-track ART with 63% (626/990) initiating ART within 7 days of linkage and 73% (723/990) initiating within 30 days, compared to 12% (237/1953) and 44% (851/1953) prior to fast-track. Retention in care after 6 months on ART was 93% in both groups. However, viral suppression rates within the first year of ART were higher in the fast-track group; 82% of those on ART for at least 6 months (510/621) had a viral load (VL) performed of whom 97% (494/510) were suppressed. In the pre fast-track group, 80% (1415/1784) had a VL performed of whom 93% (1318/1415) were suppressed (p=0.04). Median time from linkage to first viral suppression was significantly shorter following introduction of fast track ART (108 days vs 288 days, p< 0.001).
Conclusions: ART initiation, retention in care and viral suppression rates were high in HIV-infected individuals who initiated fast track ART. Time from linkage to viral suppression was significantly shorter with fast-track ART, reducing the period of potential HIV-transmission risk. These data support programmatic ART initiation efforts designed at starting ART quickly in stable patients.

Retention in Care and Viral Suppression in the Botswana Combination Prevention Project
[Retention in Care and Viral Suppression in the Botswana Combination Prevention Project]