Proyecto Cuidado y Tratamiento en VIH: Inicio Rápido de Terapia Antirretroviral

In Africa, studies have shown that factors related to the healthcare service, such as lack of preparedness, have delayed the initiation of TAR for patients. However, factors that favor early initiation, including access to CD4 count tests at the site, have also been identified. In South Africa, a study observed an increase in patients on TAR from 36% and a 26% increase in viral suppression, with viral suppression achieved in approximately 10 months. A meta-analysis found that starting TAR within the first 14 days of diagnosis increased viral suppression and retention at 12 months, without an increase in mortality or loss to follow-up. However, it is essential to ensure proper screening for opportunistic infections (IOs), as starting TAR without addressing IOs, particularly in patients with CD4 counts below 200, can lead to immune reconstitution syndrome. The current norms of attention in countries such as Guatemala and El Salvador prioritize the rapid initiation of TAR for patients with CD4 counts below 500 cells/ul, while in other countries, it applies to all patients regardless of their CD4 count. The Proyecto Cuidado y Tratamiento en VIH aims to implement the rapid initiation of TAR in the context of the current norms of attention in each country. The project will prioritize the rapid initiation of TAR for patients with CD4 counts below 500 cells/ul in Guatemala and El Salvador, while in other countries, it will apply to all patients. The project has defined a critical implementation route for the rapid initiation of TAR, which includes socializing the initiative at the local and national levels, identifying the key points in the healthcare service that are delaying the initiation of TAR, and defining a local implementation route. The project will also establish a system for tracking the implementation of the rapid initiation of TAR, including the proportion of patients who initiate TAR within 7 days, patients with pending results for IO and CD4 tests, and patients with a diagnosis of TB and/or IO. The project will also establish a reporting system to track the implementation of the rapid initiation of TAR, including the proportion of patients who initiate TAR within 7 days, patients with pending results for IO and CD4 tests, and patients with a diagnosis of TB and/or IO. The reporting system will be used to monitor the progress of the project and make adjustments as needed. The project has identified several references that support the rapid initiation of TAR, including studies that have shown the benefits of starting TAR within 7 days of diagnosis, including increased viral suppression and retention at 12 months, without an increase in mortality or loss to follow-up. The project will also consider the current norms of attention in each country and the recommendations of the OMS in implementing the rapid initiation of TAR. In conclusion, the Proyecto Cuidado y Tratamiento en VIH aims to implement the rapid initiation of TAR in the context of the current norms of attention in each country, prioritizing the rapid initiation of TAR for patients with CD4 counts below 500 cells/ul in Guatemala and El Salvador, while in other countries, it will apply to all patients. The project has defined a critical implementation route for the rapid initiation of TAR, established a system for tracking the implementation, and identified several references that support the rapid initiation of TAR.