@article{fdi:010074066,
  title = {{ART} initiation in an outpatient treatment center in {D}akar, {S}enegal : {A} retrospective cohort analysis (1998-2015)},
  author = {{N}gom, {N}. {F}. and {F}aye, {M}. {A}. and {N}diaye, {K}. and {T}hiam, {A}. and {N}dour, {C}. {T}. and {E}tard, {J}ean-{F}ran{\c{c}}ois and {S}ow, {P}. {S}. and {S}eydi, {M}. and {D}elaporte, {E}. and {C}ournil, {A}mandine},
  editor = {},
  language = {{ENG}},
  abstract = {{O}bjective {T}o examine how patient characteristics combined with {ART} eligibility expansions affect the initiation of antiretroviral therapy ({ART}) among eligible patients attending a referral center in {S}enegal from 1998 to 2015. {M}ethods {T}his is a retrospective observational study carried out at the outpatient treatment {C}entre ({C}entre de {T}raitement {A}mbulatoire) in {D}akar, {S}enegal, based on computerized medical records, gathered from 1998 to 2015, of {ART}-naive patients over 15 years of age. {ART} eligibility was defined as ({CD}4 count below 200) or as ({WHO} stage 4) or as ({WHO} stage 3 with ({CD}4 count below 350 or with unavailable {CD}4 count)) in 1998-2010; as ({CD}4 count below 350) or as ({WHO} stage 3 or 4) in 2011-2013; as ({CD}4 count below 500) or as ({WHO} stage 3 or 4) in 2014-2015. {F}our periods were defined according to {ART} eligibility expansions and {S}enegal's {HIV} care history: 1998-2003 ({P} 1), 2004-2010 ({P} 2), 2011-2013 ({P}3), and 2014-2015 ({P}4). {P}atients were expected to participate financially in their treatment during the first period ({P}1). {R}esults {A} total of 3651 patient records were included. {T}he median patient age was 40 years ({IQR}: 32-48). {W}omen represented 56% of the population. {T}he median {CD}4 count was 183 cells/mm(3). {O}verall, 53% of patients had {CD}4 < 200 cells/mm(3) at entry. {T}his proportion reached 45% in 2014-2015. 2535 patients (69%) were eligible for therapy, including 1503 (41%) who started {ART}. {T}he proportion of treated patients among those who were eligible at entry or later increased steadily from 25%, 47%, 75% to 82% in the four periods, respectively. {T}he median time to treatment decreased from 5.6 months ({IQR}: 3-11) in {P}1 to 0.8 months ({IQR}: 0-2) in {P}4. {E}ligible patients with more advanced disease ({CD}4<200 cells/mm(3) and/or clinical stage 3 or 4) were more likely to be {ART} initiated than those with {CD}4 >= 200 cells/mm(3) and/or clinical stage 1 or 2 at each stage of {ART} eligibility expansion. {C}onclusion {ART} eligibility expansions were marked by a sharp increase in the proportion of eligible patients initiating treatment. {T}hese results show that in terms of management, the target of "{T}est and {T}reat" can be easily reached but that {HIV} testing will remain a key element to improve treatment success, as illustrated by the high proportion of people with advanced stage of infection at the time of {ART} initiation.},
  keywords = {{SENEGAL} ; {DAKAR}},
  booktitle = {},
  journal = {{P}los {O}ne},
  volume = {13},
  numero = {9},
  pages = {e0202984 [15 p.]},
  ISSN = {1932-6203},
  year = {2018},
  DOI = {10.1371/journal.pone.0202984},
  URL = {https://www.documentation.ird.fr/hor/fdi:010074066},
}