{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,3,25]],"date-time":"2026-03-25T17:38:26Z","timestamp":1774460306994,"version":"3.50.1"},"reference-count":20,"publisher":"Wiley","issue":"1","license":[{"start":{"date-parts":[[2020,9,2]],"date-time":"2020-09-02T00:00:00Z","timestamp":1599004800000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["HIV Medicine"],"published-print":{"date-parts":[[2021,1]]},"abstract":"<jats:sec><jats:title>Objectives<\/jats:title><jats:p>Universal test and treat (UTT) is recommended for people living with HIV (PLHIV) to reduce morbidity\/mortality and minimize transmission. However, concerns exist that this strategy may lead to more crowded hospitals, longer wait times and poorer service, adversely impacting health outcomes for clients with severe disease. We assessed how UTT was related to markers of disease progression in PLHIV overall and specifically among clients with low CD4 count\/high World Health Organization (WHO) stage.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>The analysis was conducted using data from a stepped\u2010wedge trial of UTT in 14 government\u2010managed health facilities in Eswatini from 2014 to 2017. Disease progression was defined as CD4 count falling below 200 cells\/\u00b5L or baseline value, &gt;\u00a010% weight loss, body mass index (BMI) dropping below 18.5, incident tuberculosis (TB) or HIV\u2010related death; these outcomes also were assessed individually. We assessed multivariate Cox proportional hazard models overall and specifically among clients with CD4 count &lt;\u00a0350 cells\/\u03bcL or WHO stage 3\u20134 at enrolment.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>Eight hundred and seven of 3176 clients demonstrated at least one marker of disease progression over 2339 person\u2010years of follow\u2010up. Overall, 62.4% of clients were female; 57.2% were &lt;\u00a035\u00a0years old. Compared to clients not exposed to UTT, those exposed to UTT had a lower rate of disease progression overall [adjusted hazard ratio (aHR) 0.60; 95% confidence interval (CI) 0.46\u20130.78] and a lower rate of CD4 decline (aHR 0.40; 95% CI 0.27\u20130.58). When the analysis was limited to clients with CD4 count &lt;\u00a0350 cells\/\u03bcL or WHO stage 3\u20134, UTT was not associated with disease progression (aHR 0.92; 95% CI 0.66\u20131.29).<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p>UTT reduced HIV disease progression overall and was not detrimental for clients with more severe disease.<\/jats:p><\/jats:sec>","DOI":"10.1111\/hiv.12941","type":"journal-article","created":{"date-parts":[[2020,9,2]],"date-time":"2020-09-02T13:11:58Z","timestamp":1599052318000},"page":"54-59","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":2,"title":["Universal test and treat in relation to HIV disease progression: results from a stepped\u2010wedge trial in Eswatini"],"prefix":"10.1111","volume":"22","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-1939-1307","authenticated-orcid":false,"given":"CE","family":"Boeke","sequence":"first","affiliation":[{"name":"Clinton Health Access Initiative Boston MA USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7247-4190","authenticated-orcid":false,"given":"S","family":"Khan","sequence":"additional","affiliation":[{"name":"Clinton Health Access Initiative Mbabane Eswatini"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2282-1005","authenticated-orcid":false,"given":"F","family":"Walsh","sequence":"additional","affiliation":[{"name":"Clinton Health Access Initiative Boston MA USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"A","family":"Hettema","sequence":"additional","affiliation":[{"name":"Clinton Health Access Initiative Mbabane Eswatini"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"C","family":"Lejeune","sequence":"additional","affiliation":[{"name":"Clinton Health Access Initiative Mbabane Eswatini"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4006-4650","authenticated-orcid":false,"given":"D","family":"Spiegelman","sequence":"additional","affiliation":[{"name":"Harvard T.H. Chan School of Public Health Boston MA USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"V","family":"Okello","sequence":"additional","affiliation":[{"name":"Ministry of Health Mbabane Eswatini"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8853-9603","authenticated-orcid":false,"given":"J","family":"Harwell","sequence":"additional","affiliation":[{"name":"Clinton Health Access Initiative Boston MA USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"S","family":"Mazibuko","sequence":"additional","affiliation":[{"name":"Ministry of Health Mbabane Eswatini"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"T","family":"B\u00e4rnighausen","sequence":"additional","affiliation":[{"name":"Harvard T.H. Chan School of Public Health Boston MA USA"},{"name":"Heidelberg Institute of Global Health University of Heidelberg Heidelberg Germany"},{"name":"Africa Health Research Institute (AHRI) Durban South Africa"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"311","published-online":{"date-parts":[[2020,9,2]]},"reference":[{"key":"e_1_2_7_2_1","volume-title":"Consolidated Guidelines on the Use of Antiretroviral Drugs for Treating and Preventing HIV Infection: Recommendations for a Public Health Approach","year":"2016"},{"key":"e_1_2_7_3_1","unstructured":"OkelloV.Memorandum: Re: Scale up of test and start strategy in all ART providing facilities. In: Health Mo ed.Swaziland 2016."},{"key":"e_1_2_7_4_1","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMoa1600693"},{"key":"e_1_2_7_5_1","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMoa1507198"},{"key":"e_1_2_7_6_1","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMoa1506816"},{"key":"e_1_2_7_7_1","doi-asserted-by":"publisher","DOI":"10.1002\/jia2.25048"},{"key":"e_1_2_7_8_1","doi-asserted-by":"publisher","DOI":"10.1002\/jia2.25112"},{"key":"e_1_2_7_9_1","doi-asserted-by":"publisher","DOI":"10.1002\/jia2.25239"},{"key":"e_1_2_7_10_1","doi-asserted-by":"publisher","DOI":"10.1186\/s13063-017-2128-8"},{"key":"e_1_2_7_11_1","doi-asserted-by":"publisher","DOI":"10.1007\/s11904-020-00501-6"},{"key":"e_1_2_7_12_1","doi-asserted-by":"publisher","DOI":"10.1111\/hiv.12876"},{"key":"e_1_2_7_13_1","article-title":"Early access to antiretroviral therapy versus standard of care among HIV\u2010positive participants in Eswatini in the public health sector: the MaxART stepped\u2010wedge randomized controlled trial","author":"Khan SSD","year":"2020","journal-title":"J Int AIDS Soc"},{"key":"e_1_2_7_14_1","doi-asserted-by":"publisher","DOI":"10.1111\/j.1468-1293.2005.00292.x"},{"key":"e_1_2_7_15_1","doi-asserted-by":"publisher","DOI":"10.1089\/aid.2008.0136"},{"key":"e_1_2_7_16_1","doi-asserted-by":"publisher","DOI":"10.1097\/QAD.0000000000001050"},{"key":"e_1_2_7_17_1","doi-asserted-by":"publisher","DOI":"10.1097\/QAD.0000000000002392"},{"key":"e_1_2_7_18_1","doi-asserted-by":"publisher","DOI":"10.1186\/s12981-020-00274-3"},{"key":"e_1_2_7_19_1","doi-asserted-by":"publisher","DOI":"10.7448\/IAS.20.5.21650"},{"key":"e_1_2_7_20_1","doi-asserted-by":"publisher","DOI":"10.7448\/IAS.20.5.21648"},{"key":"e_1_2_7_21_1","doi-asserted-by":"publisher","DOI":"10.1080\/09540121.2018.1441970"}],"container-title":["HIV Medicine"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1111\/hiv.12941","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/full-xml\/10.1111\/hiv.12941","content-type":"application\/xml","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1111\/hiv.12941","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2023,9,4]],"date-time":"2023-09-04T23:34:46Z","timestamp":1693870486000},"score":1,"resource":{"primary":{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/10.1111\/hiv.12941"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2020,9,2]]},"references-count":20,"journal-issue":{"issue":"1","published-print":{"date-parts":[[2021,1]]}},"alternative-id":["10.1111\/hiv.12941"],"URL":"https:\/\/doi.org\/10.1111\/hiv.12941","archive":["Portico"],"relation":{},"ISSN":["1464-2662","1468-1293"],"issn-type":[{"value":"1464-2662","type":"print"},{"value":"1468-1293","type":"electronic"}],"subject":[],"published":{"date-parts":[[2020,9,2]]},"assertion":[{"value":"2020-07-23","order":1,"name":"accepted","label":"Accepted","group":{"name":"publication_history","label":"Publication History"}},{"value":"2020-09-02","order":2,"name":"published","label":"Published","group":{"name":"publication_history","label":"Publication History"}}]}}