{"doi":"10.1111/hiv.12876","title":"Mortality under early access to antiretroviral therapy <i>vs</i>. Eswatini’s national standard of care: the MaxART clustered randomized stepped‐wedge trial","abstract":"OBJECTIVES: Current WHO guidelines recommend the treatment of all HIV-infected individuals with antiretroviral therapy (ART) to improve survival and quality of life, and decrease infection of others. MaxART is the first implementation trial of this strategy embedded within a government-managed health system, and assesses mortality as a secondary outcome. Because primary findings strongly supported scale-up of the 'treat all' strategy (hereafter Treat All), this analysis examines mortality as an additional indicator of its impact. METHODS: MaxART was conducted in 14 Eswatinian health clinics through a clinic-based stepped-wedge design, by transitioning clinics from then-national standard of care (SoC) to the Treat All intervention. All-cause, disease-related, and HIV-related mortality were analysed using the Cox proportional hazards model, censoring SoC participants at clinic transition. Median follow-up time among study participants was 292 days. There were 36/2034 deaths in SoC (1.77%) and 49/1371 deaths in Treat All (3.57%). RESULTS: Between September 2014 and August 2017, 3405 participants were enrolled. In SoC and Treat All interventions, respectively, the multivariable-adjusted 12-month all-cause mortality rates were 1.42% [95% confidence interval (CI): 0.66-2.17] and 1.60% (95% CI: 0.78-2.40), disease-related mortality rates were 1.02% (95% CI: 0.40-1.64) and 1.10% (95% CI: 0.46-1.73), and HIV-related mortality rates were 1.03% (95% CI: 0.40-1.65) and 0.99% (95% CI: 0.40-1.58). Treat All had no impact on all-cause [hazard ratio (HR) = 1.12, 95% CI: 0.58-2.18, P = 0.73], disease-related (HR = 1.04, 95% CI: 0.52-2.11, P = 0.90), or HIV-related mortality (HR = 0.93, 95% CI: 0.46-1.87, P = 0.83). CONCLUSION: There was no immediate benefit of the Treat All strategy on mortality, nor evidence of harm. Longer follow-up of participants is needed to establish long-term consequences.","journal":"HIV Medicine","year":2020,"id":106361,"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":7,"citer_count":0,"citers_with_citation_signal":0,"citers_with_endowment":0,"datacite_reuse_total":0,"is_dataset":false,"is_dataset_confidence":0.9579,"is_data_producer":false,"deposit_databanks":null,"is_oa":true,"file_count":0,"downloads":0,"has_version_chain":false,"published_date":"2020-01-01","fair_score":null,"fair_percentile":null,"algorithm_id":"datarank_citation_only_1hop_v6","ranking_scope":"data_only","authors":[{"id":332379,"name":"Donna Spiegelman","orcid":"0000-0003-4006-4650","position":1,"is_corresponding":false},{"id":513329,"name":"Shaukat Khan","orcid":"0000-0001-7247-4190","position":2,"is_corresponding":false},{"id":513330,"name":"Fiona Walsh","orcid":"0000-0003-2282-1005","position":3,"is_corresponding":false},{"id":409876,"name":"Sikhathele Mazibuko","orcid":"0000-0003-2811-2621","position":4,"is_corresponding":false},{"id":513331,"name":"Munyaradzi Pasipamire","orcid":"0000-0002-7409-6995","position":5,"is_corresponding":false},{"id":434964,"name":"Boyang Chai","orcid":null,"position":6,"is_corresponding":false},{"id":513332,"name":"Ria Reis","orcid":"0000-0001-8249-0856","position":7,"is_corresponding":false},{"id":514096,"name":"Khudzie Mlambo","orcid":null,"position":8,"is_corresponding":false},{"id":513333,"name":"Wim Delva","orcid":"0000-0001-8054-1904","position":9,"is_corresponding":false},{"id":514097,"name":"Gavin Khumalo","orcid":null,"position":10,"is_corresponding":false},{"id":514098,"name":"Mandisa Zwane","orcid":null,"position":11,"is_corresponding":false},{"id":514099,"name":"Yvette Fleming","orcid":null,"position":12,"is_corresponding":false},{"id":514100,"name":"Emma Mafara","orcid":null,"position":13,"is_corresponding":false},{"id":500888,"name":"Anita Hettema","orcid":"0000-0002-9764-2178","position":14,"is_corresponding":false},{"id":513334,"name":"Catherine Lejeune","orcid":"0000-0001-7351-0798","position":15,"is_corresponding":false},{"id":22379,"name":"Till Bärnighausen","orcid":"0000-0002-4182-4212","position":16,"is_corresponding":false},{"id":459858,"name":"Velephi Okello","orcid":"0000-0003-1155-2735","position":17,"is_corresponding":false},{"id":513328,"name":"Ariel Chao","orcid":"0000-0003-4181-7829","position":0,"is_corresponding":true}],"reference_count":16,"raw_metadata":null,"created_at":"2026-07-18T23:12:27.124515Z","pmid":"32458567","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":[]}