Promising new approach expands use of lifesaving HIV therapy

Despite clear evidence of its positive impact on the health of HIV-positive patients, antiretroviral therapy (ART) remains underused in some areas of Africa. Up to 30 percent of HIV-positive patients who are eligible to use ART either do not begin treatment or start too late to reap its full benefits.

A recent study conducted in Uganda by SEARCH researchers focused on three key barriers that often block patient access to ART. These barriers relate to health worker behaviors:

  1. Low understanding among health workers of the harm in delayed ART use.
  2. Slow processing of the test used to determine ART eligibility (CD4 cell counts).
  3. Unnecessary requirements for multiple counseling visits before starting ART.

Dr. Carol Camlin and trial team researchers
Prior studies had attempted to address one or two of those barriers, whereas this study targeted all three. Known as START-ART, the study prioritized improving health worker education, expanding the use of real-time eligibility testing, and easing counseling requirements. 

The researchers found that, among 12,024 ART-eligible patients at 20 clinics across southwestern Uganda, patients at START-ART clinics were much more likely to begin ART compared to clinics offering standard care. START-ART patients fared better than those in the control group at two key milestones:

  • They were four times more likely to begin ART on the same day that they became eligible.
  • They were two times more likely to begin ART within 14 days of becoming eligible.

It is exciting that the START-ART approach produced these dramatic improvements in ART use — and that it did so in real-world clinic settings. This study has given front-line healthcare workers around the world an effective tool to improve ART use and ultimately the health of HIV-positive patients.