It is not clear what the impact of universal test and treat (UTT) policies on HIV care outcomes among young people who are living with HIV (YLHIV). Furthermore there is a lack of data on the time when YLHIV sufferers are most vulnerable to be disengaged from care in accordance with the most recent guidelines for treatment. The long-term HIV treatment continuum a neglected tool that could provide a comprehensive knowledge of the entire population’s HIV treatment trajectories, and can be used to evaluate outcomes for different groups. Our goal was to study the effects from this UTT policy on the outcomes of longitudinal care in South African YLHIV and identify specific opportunities to re-engage this population of priority in the UTT timeframe.

Methods

With the help of medical records We conducted an retrospective cohort study of adolescents aged between 18 and 24 diagnosed with HIV between August 2015 and December 2018 at nine health facilities located in South Africa. We utilized Fine as well as Gray sub-distribution models of proportional hazards to analyze the continuum of care outcomes for the entire population and stratified by the time of diagnosis. We calculated the percentage of patients who were in every stage of the continuum in time, and also the average time that each stage within the first year after diagnosis. The estimates of sub-groups were compared using the differences.

Results

The total number of 420 YLHIV cases were included. At the time of diagnosis, 365 days later only 23% of patients had not experienced a 90-day or more lapse in treatment, and were also suppressed. Patients diagnosed during the UTT era had shorter periods of time as an ART-naive (mean difference=-19.3 days (95 percent 95% CI: -27.7, -10.9) and more time being suppressed virally (mean difference of 17.7 95% CI= 1.0, 34.4) compared with those diagnosed prior to the UTT. The majority of patients who were diagnosed during the UTT era experienced the 90-day or more lapse in treatment not able to connect diagnosis to care or initiation of ART and suppression of viral.

Conclusions

Implementation of UTT has resulted in modest improvement in the amount of time spent on ART and suppressing viral infections in South African YLHIV– but achieving UNAIDS 95-95-95 goals is still a problem. The retention of care as well as reengagement interventions that can be put in place between diagnosis and connection to treatment and between the initiation of ART and suppression of viral infections (e.g. long-term counseling) could be especially important in improving the quality of care for South African YLHIV in the UTT timeframe.

Introduction

Traditional approaches for analyzing HIV treatment and outcomes (e.g.In sub-Saharan Africa YLHIV are at risk of poor treatment and outcomes [7 9]. A meta-analysis from 2016 by Zanoni and colleagues revealed that only 14 percent of South African YLHIV ages 15 to 24 had access to an ART program [1010. When ART was accessed by those and were in care, a majority (83%) were kept in care, while 81% of them were suppressed, resulting in an overall suppression rate of 10%. These figures highlight the fact of accessing ART as among the most significant obstacles to suppression of viral transmission among South African YLHIV prior to 2016.

In accordance with the WHO’s treatment guidelines and recommendations for treatment, according to the recommendations of treatment, South African government adopted a universal test and treat (UTT) policy in September 2016, enhancing the availability of ART to everyone who suffer from HIV regardless of their clinical stage [12according to the recommendations of the World Health Organization [12. Although some studies indicate that this policy change led to improvement in several HIV treatment outcomes for South African adults living with HIV however, other studies suggest the policy change increased attrition upon treatment commencement [11 12, 12[11, 12]. It is important to note that this policy change had the potential to eliminate the principal obstacle to achieving of viral suppression in the YLHIV population discovered as a problem by Zanoni as well as colleagues in [1010. Yet, very little is known about the real consequences of this policy change on the outcomes of care over time for the YLHIV population specifically [10 13[10, 13]. The current cross-sectional evidence suggests that low retention in care and non-suppression is still prevalent among YLHIV in the age of UTT [13, 1413].

Resolving the barriers to continued engagement among YLHIV is essential for a successful end to the HIV epidemic by 2030 [9-18Yet, only there are only a few studies that have identified the precise timing to re-engage YLHIV after lapses in care during the UTT period [66. To fill in the gaps in the research, we use the long-term HIV care continuum in order to (1) examine the consequences of the effects of UTT treatment policy in HIV treatment outcomes for people living with YLHIV living in rural South Africa and (2) find out the time-specific opportunities to re-engage this population in HIV treatment in the UTT treatment period.