{"doi":"10.1093/cid/ciab650","title":"CD4+ T-Cell Count at Antiretroviral Therapy Initiation in the “Treat-All” Era in Rural South Africa: An Interrupted Time Series Analysis","abstract":"BACKGROUND: South Africa implemented universal test and treat (UTT) in September 2016 in an effort to encourage earlier initiation of antiretroviral therapy (ART). METHODS: We therefore conducted an interrupted time series (ITS) analysis to assess the impact of UTT on mean CD4 count at ART initiation among adults aged ≥16 years attending 17 public sector primary care clinics in rural South Africa, between July 2014 and March 2019. RESULTS: Among 20 599 individuals (69% women), CD4 counts were available for 74%. Mean CD4 at ART initiation increased from 317.1 cells/μL (95% confidence interval [CI], 308.6 to 325.6) 1 to 8 months prior to UTT to 421.0 cells/μL (95% CI, 413.0 to 429.0) 1 to 12 months after UTT, including an immediate increase of 124.2 cells/μL (95% CI, 102.2 to 146.1). However, mean CD4 count subsequently fell to 389.5 cells/μL (95% CI, 381.8 to 397.1) 13 to 30 months after UTT but remained above pre-UTT levels. Men initiated ART at lower CD4 counts than women (-118.2 cells/μL, 95% CI, -125.5 to -111.0) throughout the study. CONCLUSIONS: Although UTT led to an immediate increase in CD4 count at ART initiation in this rural community, the long-term effects were modest. More efforts are needed to increase initiation of ART early in those living with human immunodeficiency virus, particularly men.","journal":"Clinical Infectious Diseases","year":2021,"id":174605,"datarank":0.0,"base_score":0.0,"endowment":0.0,"self_citation_contribution":0.0,"citation_network_contribution":0.0,"self_endowment_contribution":0.0,"citer_contribution":0.0,"corpus_percentile":null,"corpus_rank":null,"citation_count":23,"citer_count":0,"citers_with_citation_signal":0,"citers_with_endowment":0,"datacite_reuse_total":0,"is_dataset":false,"is_dataset_confidence":0.9436,"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":393192,"name":"Hae‐Young Kim","orcid":"0000-0002-5124-1555","position":1,"is_corresponding":false},{"id":364615,"name":"Kathy Petoumenos","orcid":"0000-0001-7534-7154","position":2,"is_corresponding":false},{"id":481535,"name":"Frank A. Post","orcid":"0000-0002-2844-1612","position":3,"is_corresponding":false},{"id":376620,"name":"Awachana Jiamsakul","orcid":"0000-0003-4810-0783","position":4,"is_corresponding":false},{"id":61459,"name":"Jan‐Walter De Neve","orcid":"0000-0003-0090-8249","position":5,"is_corresponding":false},{"id":39224,"name":"Frank Tanser","orcid":"0000-0001-9797-0000","position":6,"is_corresponding":false},{"id":250375,"name":"Collins Iwuji","orcid":"0000-0003-2045-1717","position":7,"is_corresponding":false},{"id":511550,"name":"Kathy Baisley","orcid":"0000-0003-1849-6625","position":8,"is_corresponding":false},{"id":250376,"name":"Maryam Shahmanesh","orcid":"0000-0001-7129-8535","position":9,"is_corresponding":false},{"id":69670,"name":"Deenan Pillay","orcid":"0000-0003-2431-244X","position":10,"is_corresponding":false},{"id":69650,"name":"Mark J. Siedner","orcid":"0000-0003-3506-842X","position":11,"is_corresponding":false},{"id":22379,"name":"Till Bärnighausen","orcid":"0000-0002-4182-4212","position":12,"is_corresponding":false},{"id":231224,"name":"Jacob Bor","orcid":"0000-0002-5112-8536","position":13,"is_corresponding":false},{"id":481532,"name":"H. Manisha Yapa","orcid":"0000-0002-0100-4754","position":0,"is_corresponding":true}],"reference_count":46,"raw_metadata":null,"created_at":"2026-07-18T23:47:06.584146Z","pmid":"34309633","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":[]}