Background: The World Health Organization (WHO) has recommended same-day antiretroviral therapy (SDART) for clients who are ready. Since 2017, Thailand has scaled up SDART in five provinces, with different models based on laboratory requirements to facilitate ART initiation. This study aims to describe and evaluate initial outcomes from the various SDART models.
Methods: Data was obtained from HIV-positive clients from nine facilities in five provinces (Chiang Rai, Chiang Mai, Chonburi, Bangkok and Songkhla) between July 2017-December 2018. Baseline laboratory tests and chest X-rays were performed according to national guidelines. ART eligibility was determined by a physician. Facilities were categorized, by the need to have laboratory results prior to ART initiation, into Group 1: no laboratory results needed, Group 2: CD4 count needed, and Group 3: safety laboratory results needed, without CD4 count. Logistic regression was performed to identify factors associated with successful SDART initiation and ART-related adverse events.
Results: Results presented are in order of Groups 1, 2, and 3. Of 2,876, 236, and 227 clients tested HIV-positive, SDART acceptability was 89.4%, 99.6%, and 93%. ART was initiated in 86.5%, 84.7%, and 81.5%. Median (IQR) CD4 count was 298 (200-423), 290 (77-427), and 233 (80-371) cells/mm3 (p< 0.001). SDART initiation was 78.4%, 45.7%, and 57% (p< 0.001). There were 4 and 1 deaths in Groups 1 and 3, respectively. None was related to immune reconstitution inflammatory syndrome. Being in Group 1 (aOR 6.15, 95%CI 3.86-9.79, p< 0.001) and Group 3 (aOR 2.15, 95%CI 1.2-3.84, p=0.010) increased the chance for SDART initiation. When looking at individual hospital and excluding a stand-alone, VCT clinic, being newly diagnosed (aOR 0.51, 95%CI 0.29-0.88, p=0.015), abnormal ALT (aOR 0.47, 95%CI 0.23-0.98, p=0.044), and abnormal chest x-rays (aOR 0.16, 95%CI 0.05-0.57, p=0.004) decreased the likelihood of starting ART on same-day. No factor was determined to be correlated to ART-related adverse events.
Conclusions: Various SDART models have been explored in Thailand and all models were proved to be feasible and safe in different hospital settings. Requirement to have CD4 count prior to ART initiation, as still commonly practiced, could unnecessarily delay ART initiation without clinical benefits.