Toward Universal HIV Treatment in Haiti: Time Trends in ART Retention Following Expanded ART Eligibility in a National Cohort from 2011-17

BACKGROUND: The World Health Organization (WHO) recommends universal antiretroviral therapy (ART) for people living with HIV (PLWH), but evidence about effects of expanded ART access on ART retention in low-resource settings is limited. SETTING: Haiti's Ministry of Health endorsed universal ART for pregnant women in March 2013 (Option B+) and for all PLWH in July 2016. This study included 51,579 ART patients from 2011-17 at 94 hospitals and clinics in Haiti. METHODS: This observational, retrospective cohort study described time trends in 6-month ART retention using secondary data, and compared results during three time periods using an interrupted time series (ITS) model: pre-Option B+ (period 1: 1/11-2/13), Option B+ (period 2: 3/13-6/16), and Test and Start (TS 95% confidence interval [CI]: 1.002-1.026, p 30 days after HIV diagnosis (aIRR=0.86; 95% CI: 0.84-0.89, p<0.001). CONCLUSION: Achieving targets for HIV epidemic control will require increasing ART retention and reducing the disparity in retention for those with same-day ART.