{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,4,28]],"date-time":"2026-04-28T12:32:41Z","timestamp":1777379561776,"version":"3.51.4"},"reference-count":37,"publisher":"SAGE Publications","issue":"1","license":[{"start":{"date-parts":[[2019,12,31]],"date-time":"2019-12-31T00:00:00Z","timestamp":1577750400000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/journals.sagepub.com\/page\/policies\/text-and-data-mining-license"}],"content-domain":{"domain":["journals.sagepub.com"],"crossmark-restriction":true},"short-container-title":["AIDS Research and Human Retroviruses"],"published-print":{"date-parts":[[2020,1]]},"abstract":"<jats:p>\n                    Before the 2015 implementation of \u201cTest and Start,\u201d the initiation of combination antiretroviral therapy (ART) was guided by specific CD4 cell count thresholds. As scale-up efforts progress, the prevalence of advanced HIV disease at ART initiation is expected to decline. We analyzed the temporal trends in the median CD4 cell counts among adults initiating ART and described factors associated with initiating ART with severe immunodeficiency in Zamb\u00e9zia Province, Mozambique. We included all HIV-positive, treatment-naive adults (age \u2265 15 years) who initiated ART at a Friends in Global Health (FGH)-supported health facility between September 2012 and September 2017. Quantile regression and multivariable logistic regression models were applied to ascertain the median change in CD4 cell count and odds of initiating ART with severe immunodeficiency, respectively. A total of 68,332 patients were included in the analyses. The median change in CD4 cell count under \u201cTest and Start\u201d was higher at +68 cells\/mm\n                    <jats:sup>3<\/jats:sup>\n                    (95% CI: 57.5\u201378.4) compared with older policies. Younger age and female sex (particularly those pregnant\/lactating) were associated with higher median CD4 cell counts at ART initiation. Male sex, advanced age, WHO Stage 4 disease, and referrals to the health facility through inpatient provider-initiated testing and counseling (PITC) were associated with higher odds of initiating ART with severe immunodeficiency. Although there were reassuring trends in increasing median CD4 cell counts with ART initiation, ongoing efforts are needed that target universal HIV testing to ensure the early initiation of ART in men and older patients.\n                  <\/jats:p>","DOI":"10.1089\/aid.2019.0043","type":"journal-article","created":{"date-parts":[[2019,7,30]],"date-time":"2019-07-30T08:11:22Z","timestamp":1564474282000},"page":"39-47","update-policy":"https:\/\/doi.org\/10.1177\/sage-journals-update-policy","source":"Crossref","is-referenced-by-count":2,"title":["Immunodeficiency at Antiretroviral Therapy Start: Five-Year Adult Data (2012\u20132017) Based on Evolving National Policies in Rural Mozambique"],"prefix":"10.1177","volume":"36","author":[{"given":"Folasade","family":"Arinze","sequence":"first","affiliation":[{"name":"Department of Internal Medicine, WellStar Health System, Marietta, Georgia."},{"name":"Department of Medicine, Vanderbilt University Medical Center (VUMC), Nashville, Tennessee."}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Wu","family":"Gong","sequence":"additional","affiliation":[{"name":"Department of Biostatistics, Vanderbilt University Medical Center (VUMC), Nashville, Tennessee."}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Ann F.","family":"Green","sequence":"additional","affiliation":[{"name":"Vanderbilt Institute for Global Health (VIGH), Nashville, Tennessee."}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Caroline","family":"De Schacht","sequence":"additional","affiliation":[{"name":"Friends in Global Health (FGH), Maputo, Mozambique."}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"James G.","family":"Carlucci","sequence":"additional","affiliation":[{"name":"Vanderbilt Institute for Global Health (VIGH), Nashville, Tennessee."},{"name":"Department of Pediatrics, Microbiology, and Immunology, Vanderbilt University Medical Center (VUMC), Nashville, Tennessee."}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Wilson","family":"Silva","sequence":"additional","affiliation":[{"name":"Friends in Global Health (FGH), Maputo, Mozambique."},{"name":"Department of Pathology, Microbiology, and Immunology, Vanderbilt University Medical Center (VUMC), Nashville, Tennessee."}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Gael","family":"Claquin","sequence":"additional","affiliation":[{"name":"Friends in Global Health (FGH), Maputo, Mozambique."}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Jos\u00e9 A.","family":"Tique","sequence":"additional","affiliation":[{"name":"Friends in Global Health (FGH), Maputo, Mozambique."}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Marzio","family":"Stefanutto","sequence":"additional","affiliation":[{"name":"Friends in Global Health (FGH), Maputo, Mozambique."}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Erin","family":"Graves","sequence":"additional","affiliation":[{"name":"Vanderbilt Institute for Global Health (VIGH), Nashville, Tennessee."}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Sara","family":"Van Rompaey","sequence":"additional","affiliation":[{"name":"Friends in Global Health (FGH), Maputo, Mozambique."}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Maria Fernanda Sardella","family":"Alvim","sequence":"additional","affiliation":[{"name":"Friends in Global Health (FGH), Maputo, Mozambique."}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Sim\u00e3o","family":"Tomo","sequence":"additional","affiliation":[{"name":"Direc\u00e7\u00e3o Provincial de Sa\u00fade Zamb\u00e9zia (DPS-Z), Quelimane, Mozambique."}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Troy D.","family":"Moon","sequence":"additional","affiliation":[{"name":"Vanderbilt Institute for Global Health (VIGH), Nashville, Tennessee."},{"name":"Department of Pediatrics, Microbiology, and Immunology, Vanderbilt University Medical Center (VUMC), Nashville, Tennessee."}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"C. William","family":"Wester","sequence":"additional","affiliation":[{"name":"Department of Medicine, Vanderbilt University Medical Center (VUMC), Nashville, Tennessee."},{"name":"Vanderbilt Institute for Global Health (VIGH), Nashville, Tennessee."}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"179","published-online":{"date-parts":[[2019,12,31]]},"reference":[{"key":"e_1_3_6_2_2","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMoa1506816"},{"key":"e_1_3_6_3_2","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMp1502020"},{"key":"e_1_3_6_4_2","first-page":"CD008272","article-title":"Optimal time for initiation of antiretroviral therapy in asymptomatic, HIV-infected, treatment-naive adults","volume":"3","author":"Siegfried N","year":"2010","unstructured":"Siegfried N, , Uthman OA, , Rutherford GW: Optimal time for initiation of antiretroviral therapy in asymptomatic, HIV-infected, treatment-naive adults. 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