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Engagement in care, viral suppression, drug resistance and reasons for non-engagement after home-based same-day ART initiation in Lesotho: a two-year follow-up of the CASCADE trial

Type of publication Peer-reviewed
Publikationsform Original article (peer-reviewed)
Author Amstutz Alain, Brown Jennifer Anne, Ringera Isaac, Muhairwe Josephine, Lejone Thabo Ishmael, Klimkait Thomas, Glass Tracy Renée, Labhardt Niklaus Daniel,
Project Supporting Lesotho on the way towards the UNAIDS 90-90-90 targets: Operational and clinical research addressing HIV/AIDS care in resource-limited settings
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Original article (peer-reviewed)

Journal Clinical Infectious Diseases
Page(s) 0
Title of proceedings Clinical Infectious Diseases
DOI 10.1093/cid/ciz1126

Open Access

Type of Open Access Publisher (Gold Open Access)


AbstractBackgroundThe CASCADE trial showed that compared to usual care (UC), offering same-day (SD) ART during home-based HIV testing improved engagement in care and viral suppression 12 months after diagnosis. However, open questions remain regarding long-term outcomes and the risk of propagating drug resistance.MethodsAfter completion of the primary endpoint at 12 months, participants not in care in both arms were traced and encouraged to access care. At 24 months, the following outcomes were assessed in both arms: Engagement in care, viral suppression, and reasons for non-engagement. Furthermore, we explored among SD arm non-linkers the acquisition of drug resistance mutations (DRMs).ResultsAt 24 months, 64% (88/137) in the SD vs 59% (81/137) in the UC arm were in care (absolute difference 5%; 95%CI -6-16; p=0.38) and 57% (78/137) vs 54% (74/137) had documented viral suppression (3%; -9-15; p=0.28). Among 36 participants alive and not in care at 24 months with ascertained status, the majority rejected contact with the health system or were unwilling to take ART. Among eight interviewed SD arm non-linkers, six had not initiated ART upon enrolment and no acquired DRMs were detected. Two had taken the initial 30-day ART supply and acquired DRMs.ConclusionsSD ART resulted in higher rates of engagement in care and viral suppression at 12 but not 24 months. Levelling off between both arms was driven by linkage beyond 12 months in the UC arm. We did not observe compensatory long-term disengagement in the SD arm. These long-term results endorse SD ART initiation policies.