Adherence to Antiretroviral Treatment Among People Who Started Treatment on the Same-Day of HIV Diagnosis in Ethiopia: A Multicenter Observational Study

Introduction: Since the launch of universal "test and treat" approach in 2016, there has been a significant increase in persons initiated on antiretroviral therapy (ART) on the same-day of human immunodeficiency virus (HIV) diagnosis in low-income settings. However, there are limited studies that investigated the effect of rapid treatment initiation on adherence. In this study, we compared adherence to ART in people who started ART on the same-day of HIV diagnosis and those started more than 7 days after HIV diagnosis. Methods: We conducted a retrospective cohort analysis using routinely collected data from multiple ART clinics. Participants were at least 15 years old, were newly diagnosed and started on ART between October 2016 and July 2018 in the Amhara region of Ethiopia. We used doubly-robust multivariable logistic regression model to estimate the adjusted effects on adherence. Results: A total of 415 individuals who started ART on the same-day of HIV diagnosis and 527 individuals who started 7 days after their HIV diagnosis were included in the analysis. The proportion of participants who reported optimal adherence was significantly lower in the same-day group at 6- and 12-months (absolute risk difference of 6.5%; 95% CI: 1.1%, 11.9% and 6.8%; 95% CI: 1.2%, 12.5%, respectively) compared to the >7 days group. After adjusting for baseline and non-baseline covariates, the same-day group was less likely to have optimal adherence both at 6- and 12-months (adjusted RR=0.90; 95% CI: 0.86, 0.94 and RR=0.89; 95% CI: 0.83, 0.95, respectively) compared to the >7 days group. Conclusion: We observed lower optimal adherence among individuals who started ART on the same-day of HIV diagnosis compared to those who started ART >7 days after their HIV diagnosis. Our findings highlight the importance of identifying adherence barriers, providing support, and ensuring treatment readiness before initiating individuals on same-day ART.