In its 2017 revision of the global guidelines for HIV care and treatment, the World Health Organization called for accelerating the process of initiating antiretroviral therapy (ART) for patients with HIV, whenever possible starting ART on the same day that a patient tests positive for HIV. The goals of this policy are to start treatment earlier, reduce the loss to care of patients who don\u2019t return to the clinic after a positive test, and make the delivery of HIV services more efficient for both providers and patients.<\/p>\n
Following on the widely cited\u00a0<\/span>RapIT<\/a>\u00a0<\/span>study of rapid ART initiation, DGH researchers and our colleagues in South Africa and Kenya conducted the\u00a0<\/span>SLATE I<\/a>\u00a0<\/span>study. SLATE, which stands for\u00a0Simplified Algorithm for Treatment Eligibility<\/a>\u00a0was a pragmatic, individually randomized evaluation of an algorithm that used a self-reported symptoms, medical history, readiness assessment, and brief physical examination to assess whether an adult patient is eligible for immediate same-day treatment initiation. SLATE I follow up was completed in December 2018. The SLATE algorithm increased the proportion of treatment-eligible patients who initiated ART within 28 days by 15% in South Africa and 6% in Kenya. Roughly half of all patients in the intervention arm, however, were found ineligible for same-day initiation, due mostly to having symptoms of TB. Full results<\/a> of SLATE I have been published, and a summary<\/a> is available here.<\/p>\n In response to early findings from SLATE I, the\u00a0<\/span>SLATE II<\/a>\u00a0study was launched in South Africa in March 2018. Like SLATE I, SLATE II is an individually randomized, pragmatic evaluation of a clinical algorithm to reliably determine a patient\u2019s eligibility for immediate ART initiation without waiting for laboratory results or additional clinic visits. Compared to SLATE I, the SLATE II algorithm had fewer reasons for a patient not to be eligible for same-day initiation. In particular, it handled TB symptoms differently, allowing patients without serious, overt TB disease to start ART immediately, rather than automatically delaying ART initiation.<\/p>\n SLATE II follow up was completed in May 2019. The SLATE II algorithm increased the proportion of treatment-eligible patients who initiated ART within 7 days\u2014the new global target\u2014from 64% to 92%. Under SLATE II, 86% of HIV-positive patients walking in the clinic door were eligible for same-day initiation, a marked improvement on SLATE I.<\/p>\n Funded by The Bill & Melinda Gates Foundation, the SLATE studies arose from a 2015 global technical consultation on Models for Accelerating Treatment Initiation, whose recommendations for a research agenda are available\u00a0here<\/a>.<\/p>\n