Impact of Universal Antiretroviral Treatment Eligibility on Rapid Treatment Initiation Among Young Adolescents with Human Immunodeficiency Virus in Sub-Saharan Africa

J Infect Dis. 2020 Aug 4;222(5):755-764. doi: 10.1093/infdis/jiz547.


Background: Young adolescents with perinatally acquired human immunodeficiency virus (HIV) are at risk for poor care outcomes. We examined whether universal antiretroviral treatment (ART) eligibility policies (Treat All) improved rapid ART initiation after care enrollment among 10-14-year-olds in 7 sub-Saharan African countries.

Methods: Regression discontinuity analysis and data for 6912 patients aged 10-14-years were used to estimate changes in rapid ART initiation (within 30 days of care enrollment) after adoption of Treat All policies in 2 groups of countries: Uganda and Zambia (policy adopted in 2013) and Burundi, Democratic Republic of the Congo, Kenya, Malawi, and Rwanda (policy adopted in 2016).

Results: There were immediate increases in rapid ART initiation among young adolescents after national adoption of Treat All. Increases were greater in countries adopting the policy in 2016 than in those adopting it in 2013: 23.4 percentage points (pp) (95% confidence interval, 13.9-32.8) versus 11.2pp (2.5-19.9). However, the rate of increase in rapid ART initiation among 10-14-year-olds rose appreciably in countries with earlier treatment expansions, from 1.5pp per year before Treat All to 7.7pp per year afterward.

Conclusions: Universal ART eligibility has increased rapid treatment initiation among young adolescents enrolling in HIV care. Further research should assess their retention in care and viral suppression under Treat All.

Keywords: ART eligibility; ART initiation; Treat All; adolescents; regression discontinuity; sub-Saharan Africa.

Publication types

  • Research Support, N.I.H., Extramural

MeSH terms

  • Adolescent
  • Africa South of the Sahara
  • Anti-Retroviral Agents / therapeutic use*
  • Child
  • Eligibility Determination
  • Female
  • HIV Infections / drug therapy*
  • Health Policy*
  • Humans
  • Longitudinal Studies
  • Male
  • Time Factors


  • Anti-Retroviral Agents