Immediate and Early Engagement of Same-Day Antiretroviral Therapy Initiation among newly diagnosed people living with HIV in Urban Zambia: A Retrospective Cohort Study

Introduction As Zambia moves towards attaining human immunodeficiency virus (HIV) epidemic control, it is clear significant efforts are required to facilitate achievement of UNAIDS treatment targets by 2030. To accelerate progress towards global target of 95% of people living with HIV (PLHIV) knowing their status, country is promoting community based HIV testing and same day antiretroviral therapy (ART) initiation. However, there are uncertainties around acceptability of this strategy and how it affects immediate and early engagement in program settings. Methods We included all newly diagnosed PLHIV aged 18 years or older and provided same day ART initiation between October 2018 and January 2019 in Lusaka District. Immediate engagement was estimated as proportion of newly diagnosed PLHIV who visited the health facility at least once within 14 days after same-day ART initiation, whereas early engagement as proportion of newly diagnosed PLHIV active 6 months after same day ART initiation. Pearson’s chi-squared test was used to assess association of outcomes with key background characteristics. Results Of 12,777 newly diagnosed PLHIV who initiated same day ART 7,943 (62%) were tested and initiated in the community. Overall, 6,257 (49%) engaged within 14 days (median 15, IQR:13 37). Older individuals (36-49 years) were more likely to be engaged at 14 days (aRR 1.29: 95%CI 1.06-1.18; p<0.001) and retained at 6 months (aRR:1.27;95%CI 1.21-1.34P<0.001) whilst risk of attrition at 6 months was highest in younger ages (18-24 years) (aRR 0.79;95 %CI 0.76-0.82; p<0.001). Conclusion To adequately address the HIV epidemic targeted engagement approaches are required particularly in the younger ages. ### Competing Interest Statement The authors have declared no competing interest. ### Funding Statement The President Emergency Plan for AIDS Relief (PEPFAR) through the US Center for Disease Control and Prevention/ Zambia (CDC Zambia) and the Centre for Infectious Disease Research in Zambia (CIDRZ). ### Author Declarations I confirm all relevant ethical guidelines have been followed, and any necessary IRB and/or ethics committee approvals have been obtained. Yes The details of the IRB/oversight body that provided approval or exemption for the research described are given below: Approval to review existing, deidentified, routinely collected programmatic data was provided by the U.S. Centers for Disease Control & Prevention (2018-381), University of Zambia Biomedical Research Ethics Committee (011-12- 17), University of North Carolina at Chapel Hill, USA (18-0854) and the Institutional Review Board at Washington University, St. Louis, USA (2019-11143). I confirm that all necessary patient/participant consent has been obtained and the appropriate institutional forms have been archived, and that any patient/participant/sample identifiers included were not known to anyone (e.g., hospital staff, patients or participants themselves) outside the research group so cannot be used to identify individuals. Yes I understand that all clinical trials and any other prospective interventional studies must be registered with an ICMJE-approved registry, such as ClinicalTrials.gov. I confirm that any such study reported in the manuscript has been registered and the trial registration ID is provided (note: if posting a prospective study registered retrospectively, please provide a statement in the trial ID field explaining why the study was not registered in advance). Yes I have followed all appropriate research reporting guidelines and uploaded the relevant EQUATOR Network research reporting checklist(s) and other pertinent material as supplementary files, if applicable. Yes The Government of Zambia allows data sharing when applicable local conditions are satisfied. In this case, the data from the study will be made available to any interested researchers upon request. The CIDRZ Ethics and Compliance Committee is responsible for approving such request. To request data access, one must write to the Committee chair/Chief Scientific Officer, Dr. Roma Chilengi, (Roma.Chilengi@cidrz.org) or the Secretary to the Committee/Head of Research Operations, Ms. Hope Mwanyungwi (Hope.Mwanyungwi@cidrz.org) mentioning the intended use for the data. The Committee will then facilitate review and authorization to release the data as requested. Data requests must include contact information, a research project title, and a description of the intended use.