Better outcomes among HIV-infected Rwandan children 18-60 months following the implementation of "treat all".

BACKGROUND: In 2012, Rwanda introduced a Treat All approach for HIV-infected children under age 5. We compared antiretroviral therapy (ART) initiation, outcomes, and retention, before and after this change.

METHODS: We conducted a retrospective study of children enrolled into care between June 2009-December 2011 (Before Treat All cohort [BTA]) and between July 2012-April 2015 (Treat All cohort [TA]).

SETTING: Medical records of a nationally representative sample were abstracted for all eligible aged 18-60 months from 100 Rwandan public health facilities.

RESULTS: We abstracted 374 medical records: 227 in the BTA and 147 in the TA cohorts. Mean (SD) age at enrollment was (3 years [1.1]). Among BTA, 59% initiated ART within one year, vs. 89% in the TA cohort. Median time to ART initiation was 68 days (IQR 14-494) for BTA and 9 days (IQR 0-28) for TA (p<0.0001), with 9 (5%) undergoing same-day initiation in BTA compared to 50 (37%) in TA (p < 0.0001).Before ART initiation, 59% in the BTA reported at least one health condition compared to 35% in the TA cohort (p < 0.0001).While overall loss to follow-up (LTFU) was similar between cohorts (BTA: 13%, TA: 8%, p = 0.18), LTFU prior to ART was significantly higher in the BTA (8%) compared to the TA cohort (2%) (p = 0.02).

CONCLUSIONS: Nearly 90% of Rwandan children started on ART within one year of enrollment; most within 1 month, with greater than 90% retention following implementation of TA. TA was also associated with fewer morbidities.This is an open-access article distributed under the terms of the Creative Commons Attribution-Non Commercial-No Derivatives License 4.0 (CCBY-NC-ND) , where it is permissible to download and share the work provided it is properly cited. The work cannot be changed in any way or used commercially without permission from the journal.