Abstract:
Objective: We conducted a retrospective cohort study to evaluate the efficacy of the
World Health Organization (WHO) "Universal Test and Treat" (UTT) policy, initiated in
Kenya in September 2016. Under this policy, every human immunodeficiency virus
(HIV)-infected person should be initiated on antiretroviral therapy (ART). We compared
intra- and inter-group viral suppression and ART adherence rates for pre-UTT (initiated
on ART in March-August 2016) and UTT groups (initiated in September 2016). The
study was conducted in a community outreach Program in Nairobi with 3500 HIVinfected children enrolled.
Results: 122 children and adolescents were initiated on first-line ART pre-UTT, and 197
during the UTT period. The 6 month viral suppression rate was 79.7% pre-UTT versus
76.6% UTT (P < 0.05). Suboptimal adherence was higher in the UTT than pre-UTT
period (88 of 197, 44.7% and 44 of 122, 34%; P < 0.001). The decrease in adherence was
greater among orphans (91.7% pre-UTT and 87.2% UTT, P = 0.001) and children 11-18
years. Our results show that successful implementation of the UTT policy in Africa is
challenged by an increased risk of suboptimal adherence. There is a need to develop
extra strategies to support adherence, especially among orphans and teenagers.