{"doi":"10.1093/cid/ciab222","title":"Effects of National Adoption of Treat-All Guidelines on Pre-Antiretroviral Therapy (ART) CD4 Testing and Viral Load Monitoring After ART initiation: A Regression Discontinuity Analysis","abstract":"BACKGROUND: The World Health Organization's Treat-All guidance recommends CD4 testing before initiating antiretroviral therapy (ART), and routine viral load (VL) monitoring (over CD4 monitoring) for patients on ART. METHODS: We used regression discontinuity analyses to estimate changes in CD4 testing and VL monitoring among 547 837 ART-naive patients enrolling in human immunodeficiency virus (HIV) care during 2006-2018 at 225 clinics in 26 countries where Treat-All policies were adopted. We examined CD4 testing within 12 months before and VL monitoring 6 months after ART initiation among adults (≥20 years), adolescents (10-19 years), and children (0-9 years) in low/lower-middle-income countries (L/LMICs) and high/upper-middle-income countries (H/UMICs). RESULTS: Treat-All adoption led to an immediate decrease in pre-ART CD4 testing among adults in L/LMICs, from 57.0% to 48.1% (-8.9 percentage points [pp]; 95% CI: -11.0, -6.8), and a small increase in H/UMICs, from 90.1% to 91.7% (+1.6pp; 95% CI: 0.2, 3.0), with no changes among adolescents or children; decreases in pre-ART CD4 testing accelerated after Treat-All adoption in L/LMICs. In L/LMICs, VL monitoring after ART initiation was low among all patients in L/LMICs before Treat-All; while there was no immediate change at Treat-All adoption, VL monitoring trends significantly increased afterwards. VL monitoring increased among adults immediately after Treat-All adoption, from 58.2% to 61.1% (+2.9pp; 95% CI: 0.5, 5.4), with no significant changes among adolescents/children. CONCLUSIONS: While on-ART VL monitoring has improved in L/LMICs, Treat-All adoption has accelerated and disparately worsened suboptimal pre-ART CD4 monitoring, which may compromise care outcomes for individuals with advanced HIV.","journal":"Clinical Infectious Diseases","year":2021,"id":168444,"datarank":1.412584287414226,"base_score":3.4339872044851463,"endowment":3.4339872044851463,"self_citation_contribution":0.515098080672772,"citation_network_contribution":0.8974862067414542,"self_endowment_contribution":0.515098080672772,"citer_contribution":0.8974862067414542,"corpus_percentile":null,"corpus_rank":null,"citation_count":30,"citer_count":14,"citers_with_citation_signal":12,"citers_with_endowment":12,"datacite_reuse_total":0,"is_dataset":false,"is_dataset_confidence":0.9503,"is_data_producer":false,"deposit_databanks":null,"is_oa":true,"file_count":0,"downloads":0,"has_version_chain":false,"published_date":"2021-01-01","fair_score":null,"fair_percentile":null,"algorithm_id":"datarank_citation_only_1hop_v6","ranking_scope":"data_only","authors":[{"id":697803,"name":"Olga Tymejczyk","orcid":"0000-0002-8417-0650","position":1,"is_corresponding":false},{"id":559187,"name":"Elizabeth Zaniewski","orcid":"0000-0003-1986-2359","position":2,"is_corresponding":false},{"id":4469,"name":"Matthias Egger","orcid":"0000-0001-7462-5132","position":3,"is_corresponding":false},{"id":445699,"name":"Kara Wools‐Kaloustian","orcid":"0000-0002-3277-4452","position":4,"is_corresponding":false},{"id":512364,"name":"Constantin T. Yiannoutsos","orcid":"0000-0001-9014-3651","position":5,"is_corresponding":false},{"id":277849,"name":"Antoine Jaquet","orcid":"0000-0002-3426-9492","position":6,"is_corresponding":false},{"id":240243,"name":"Keri N. Althoff","orcid":"0000-0002-5068-6595","position":7,"is_corresponding":false},{"id":340163,"name":"Jennifer Lee","orcid":"0000-0003-3971-0766","position":8,"is_corresponding":false},{"id":499748,"name":"Yanink Caro‐Vega","orcid":"0000-0001-9212-1560","position":9,"is_corresponding":false},{"id":669013,"name":"Paula M. Luz","orcid":"0000-0001-9746-719X","position":10,"is_corresponding":false},{"id":697804,"name":"Junko Tanuma","orcid":"0000-0002-1697-7364","position":11,"is_corresponding":false},{"id":595330,"name":"Théodore Niyongabo","orcid":null,"position":12,"is_corresponding":false},{"id":104608,"name":"Denis Nash","orcid":"0000-0002-3280-5386","position":13,"is_corresponding":false},{"id":277850,"name":"Ellen Brazier","orcid":"0000-0002-8514-1958","position":0,"is_corresponding":true}],"reference_count":35,"raw_metadata":{"citation_network_status":"fetched"},"created_at":"2026-07-18T23:46:06.853307Z","pmid":"33693517","pmcid":null,"fwci":null,"citation_percentile":null,"influential_citations":0,"oa_status":null,"license":null,"views":0,"total_file_size_bytes":0,"version_count":0,"fair_f":null,"fair_a":null,"fair_i":null,"fair_r":null,"fair_zscore":null,"fair_rationale":null,"fair_model":null,"fair_agent_version":null,"fair_fulltext_source":null,"fair_has_llm":null,"fair_computed_at":null,"clinical_trials":[],"software_tools":[],"db_accessions":[],"linked_datasets":[],"topics":[]}