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Although there is strong evidence from clinical trials that early initiation of <jats:styled-content style=\"fixed-case\">ART<\/jats:styled-content> leads to reduced morbidity and mortality, the impact of <jats:styled-content style=\"fixed-case\">UTT<\/jats:styled-content> on retention on <jats:styled-content style=\"fixed-case\">ART<\/jats:styled-content> in real\u2010life programmatic settings in Africa is not yet known.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>We conducted a retrospective cohort study in Zomba district, Malawi to compare <jats:styled-content style=\"fixed-case\">ART<\/jats:styled-content> outcomes of patients who initiated <jats:styled-content style=\"fixed-case\">ART<\/jats:styled-content> under 2016 <jats:styled-content style=\"fixed-case\">UTT<\/jats:styled-content> guidelines and those who started <jats:styled-content style=\"fixed-case\">ART<\/jats:styled-content> prior to rollout of <jats:styled-content style=\"fixed-case\">UTT<\/jats:styled-content> (pre\u2010<jats:styled-content style=\"fixed-case\">UTT<\/jats:styled-content>). We analysed data from 32 rural and urban health facilities of various sizes. Cox proportional hazards modelling was used to determine the independent risk factors of attrition from <jats:styled-content style=\"fixed-case\">ART<\/jats:styled-content> at 12\u00a0months. All analyses were adjusted for clustering by health facility using a robust standard errors approach.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>Among 1492 patients (mean age 34.4\u00a0years, 933 (63%) female) who initiated <jats:styled-content style=\"fixed-case\">ART<\/jats:styled-content> during the study period, 501 were enrolled in the pre\u2010<jats:styled-content style=\"fixed-case\">UTT<\/jats:styled-content> cohort and 911 during <jats:styled-content style=\"fixed-case\">UTT<\/jats:styled-content>. At 12\u00a0months, retention on <jats:styled-content style=\"fixed-case\">ART<\/jats:styled-content> in the <jats:styled-content style=\"fixed-case\">UTT<\/jats:styled-content> cohort was higher than in the pre\u2010<jats:styled-content style=\"fixed-case\">UTT<\/jats:styled-content> cohort 83.0% (95% confidence interval (<jats:styled-content style=\"fixed-case\">CI<\/jats:styled-content>): 81.0% to 85.0%) versus 76.2% (95% <jats:styled-content style=\"fixed-case\">CI<\/jats:styled-content> 73.9% to 78.5%). Adolescents, aged 10 to 19\u00a0years (adjusted hazard ratio (<jats:styled-content style=\"fixed-case\">aHR<\/jats:styled-content>) 1.53; 95% <jats:styled-content style=\"fixed-case\">CI<\/jats:styled-content> 1.01 to 2.32), and women who were pregnant or breastfeeding at <jats:styled-content style=\"fixed-case\">ART<\/jats:styled-content> initiation (<jats:styled-content style=\"fixed-case\">aHR<\/jats:styled-content> 1.87; 95% <jats:styled-content style=\"fixed-case\">CI<\/jats:styled-content> 1.30 to 2.38) were at higher risk of attrition in the combined pre\u2010<jats:styled-content style=\"fixed-case\">UTT<\/jats:styled-content> and <jats:styled-content style=\"fixed-case\">UTT<\/jats:styled-content> cohort.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p>Retention on <jats:styled-content style=\"fixed-case\">ART<\/jats:styled-content> was nearly 6% higher after <jats:styled-content style=\"fixed-case\">UTT<\/jats:styled-content> introduction. Young adults and women who were pregnant or breastfeeding at the start of <jats:styled-content style=\"fixed-case\">ART<\/jats:styled-content> were at increased risk of attrition, emphasizing the need for targeted interventions for these groups to achieve the 90\u201090\u201090 <jats:styled-content style=\"fixed-case\">UNAIDS<\/jats:styled-content> targets in the <jats:styled-content style=\"fixed-case\">UTT<\/jats:styled-content> era.<\/jats:p><\/jats:sec>","DOI":"10.1002\/jia2.25239","type":"journal-article","created":{"date-parts":[[2019,2,8]],"date-time":"2019-02-08T07:15:09Z","timestamp":1549610109000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":50,"title":["Retention on antiretroviral therapy during Universal Test and Treat implementation in Zomba district, Malawi: a retrospective cohort study"],"prefix":"10.1002","volume":"22","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-2786-8443","authenticated-orcid":false,"given":"Mohammad","family":"Alhaj","sequence":"first","affiliation":[{"name":"Dalla Lana School of Public Health University of Toronto Toronto Canada"},{"name":"Dignitas International Zomba Malawi"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7071-520X","authenticated-orcid":false,"given":"Alemayehu","family":"Amberbir","sequence":"additional","affiliation":[{"name":"Dalla Lana School of Public Health University of Toronto Toronto Canada"},{"name":"Dignitas International Zomba Malawi"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Emmanuel","family":"Singogo","sequence":"additional","affiliation":[{"name":"Dignitas International Zomba Malawi"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Victor","family":"Banda","sequence":"additional","affiliation":[{"name":"Dignitas International Zomba Malawi"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Monique","family":"van Lettow","sequence":"additional","affiliation":[{"name":"Dalla Lana School of Public Health University of Toronto Toronto Canada"},{"name":"Dignitas International Zomba Malawi"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Alfred","family":"Matengeni","sequence":"additional","affiliation":[{"name":"Dignitas International Zomba Malawi"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Gift","family":"Kawalazira","sequence":"additional","affiliation":[{"name":"Zomba District Health Office Malawi Ministry of Health Zomba Malawi"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Joe","family":"Theu","sequence":"additional","affiliation":[{"name":"Dignitas International Zomba Malawi"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Megh R","family":"Jagriti","sequence":"additional","affiliation":[{"name":"Dignitas International Zomba Malawi"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9187-9465","authenticated-orcid":false,"given":"Adrienne K","family":"Chan","sequence":"additional","affiliation":[{"name":"Dalla Lana School of Public Health University of Toronto Toronto Canada"},{"name":"Dignitas International Zomba Malawi"},{"name":"Division of Infectious Diseases Sunnybrook Health Sciences Centre University of Toronto Toronto Canada"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Joep J","family":"van Oosterhout","sequence":"additional","affiliation":[{"name":"Dignitas International Zomba Malawi"},{"name":"Department of Medicine College of Medicine University of Malawi Blantyre Malawi"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"311","published-online":{"date-parts":[[2019,2,7]]},"reference":[{"key":"e_1_2_10_2_1","unstructured":"Malawi Population\u2010Based HIV Impact Assessment 2015\u20102016.Final Report.2016[cited 2019 Jan 25]. 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