Brief Report: Earlier Referral to Differentiated Antiretroviral Therapy Delivery at Six Months After Initiation: A Retrospective Cohort Study in KwaZulu-Natal, South Africa

Abstract: In April 2020, South Africa adopted the World Health Organization revised eligibility for differentiated service delivery, which changed from requiring virologically suppressed clients to be on antiretroviral therapy (ART) for 12 months to 6 months. To evaluate the uptake of early community–based ART (ec-ART) and subsequent clinical outcomes, we performed a retrospective cohort study using routine, deidentified data from 124 public clinics in KwaZulu-Natal, South Africa. We included people with HIV aged ≥16 years, newly initiated on ART and virally suppressed (P < 0.05). Among those retained-in-care, a 12-month viral load result was available for 83.4% patients, of these 9.0% with and 10.5% without ec-ART had viremia (not significantly different). Uptake of ec-ART was low but associated with better retention and similar clinical outcomes.