{
  "abstract": "Introduction Same-day initiation (SDI) of antiretroviral therapy is recommended for people presenting with HIV who have no contraindications. We reviewed the evidence on SDI interventions in low- and middle-income countries (LMICs).Methods We conducted a systematic review and meta-analysis of randomised controlled trials of SDI in adults diagnosed with HIV in LMICs. We searched MEDLINE, Embase and the Cochrane Library up to December 2024. Primary outcomes were viral suppression and retention in care 6–12 months after enrolment. Based on a qualitative assessment of the complex trial interventions, we considered two subgroups: (1) interventions newly introducing SDI and (2) interventions improving SDI implementation in settings where it was already routinely available. We conducted random-effects meta-analysis, assessed risk of bias using the ROBUST instrument and used the Grading of Recommendations Assessment, Development and Evaluation approach to assess the certainty of evidence.Results We identified 12 eligible trials, 7 introducing and 5 improving SDI. The trial interventions introducing SDI were sufficiently similar for meta-analysis. Introducing SDI likely has an important benefit for viral suppression (relative risk (RR) 1.18, 95% CI 1.06 to 1.30, moderate certainty) and retention in care (RR 1.12, 95% CI 1.00 to 1.25, low certainty) at 6–12 months The five trials improving SDI were too heterogeneous for meaningful meta-analysis. Individually, they showed either low to very low certainty for an important effect or, when implementing SDI in patients with tuberculosis (TB) symptoms, moderate to high certainty for little to no effect on viral suppression and retention in care.Conclusion Newly introducing SDI likely improves viral suppression and retention in care. However, the impact of interventions to improve SDI where already available is less clear. Two studies provided evidence against the concern that SDI may have adverse effects in participants with TB symptoms.PROSPERO registration number CRD42023482522.",
  "authors": [
    {
      "affiliations": [
        "Division of Clinical Epidemiology, Department of Clinical Research, University Hospital Basel, Basel, Switzerland"
      ],
      "name": "Nikita Sass"
    },
    {
      "affiliations": [
        "Division of Clinical Epidemiology, Department of Clinical Research, University Hospital Basel, Basel, Switzerland"
      ],
      "name": "Hanna Havrylenko"
    },
    {
      "affiliations": [
        "Division of Clinical Epidemiology, Department of Clinical Research, University Hospital Basel, Basel, Switzerland"
      ],
      "name": "Felix Gerber"
    },
    {
      "affiliations": [
        "Division of Clinical Epidemiology, Department of Clinical Research, University Hospital Basel, Basel, Switzerland",
        "Population Health Sciences, University of Bristol, Bristol, UK"
      ],
      "name": "Alain Amstutz"
    },
    {
      "affiliations": [
        "Department of Global Health, Boston University School of Public Health, Boston, Massachusetts, USA",
        "Health Economics and Epidemiology Research Office (HE2RO), University of the Witwatersrand Johannesburg, Johannesburg, South Africa"
      ],
      "name": "Sydney Rosen"
    },
    {
      "affiliations": [
        "Department of Global Health, Boston University School of Public Health, Boston, Massachusetts, USA"
      ],
      "name": "Alana Brennan"
    },
    {
      "affiliations": [
        "Health Economics and Epidemiology Research Office (HE2RO), University of the Witwatersrand Johannesburg, Johannesburg, South Africa"
      ],
      "name": "Mhairi Maskew"
    },
    {
      "affiliations": [
        "Division of Global Health Equity, Brigham and Women’s Hospital, Harvard Medical School, Boston, Massachusetts, USA"
      ],
      "name": "Serena Koenig"
    },
    {
      "affiliations": [
        "Haitian Group for the Study of Kaposi’s Sarcoma and Opportunistic Infections (GHESKIO), Port-au-Prince, Haiti"
      ],
      "name": "Nancy Dorvil"
    },
    {
      "affiliations": [
        "Division of Infectious Diseases, Washington University in St Louis, St. Louis, Missouri, USA"
      ],
      "name": "Elvin H Geng"
    },
    {
      "affiliations": [
        "Swiss Tropical and Public Health Institute, Allschwil, Switzerland"
      ],
      "name": "Tracy Glass"
    },
    {
      "affiliations": [
        "Department of Global HIV, Hepatitis and Sexually Transmitted Infections Programmes, World Health Organization, Geneva, Switzerland",
        "Centre for Infectious Disease Epidemiology and Research, University of Cape Town, Rondebosch, South Africa"
      ],
      "name": "Nathan P Ford"
    },
    {
      "affiliations": [
        "Division of Clinical Epidemiology, Department of Clinical Research, University Hospital Basel, Basel, Switzerland",
        "Department of Infectious Diseases, University Hospital Basel, Basel, Switzerland"
      ],
      "name": "Niklaus Daniel Labhardt"
    },
    {
      "affiliations": [
        "Division of Clinical Epidemiology, Department of Clinical Research, University Hospital Basel, Basel, Switzerland",
        "School of Public Health, University College Cork, Cork, Ireland"
      ],
      "name": "Stefan Schandelmaier"
    }
  ],
  "title": "Effect of same-day HIV treatment initiation (SDI) on 1-year outcomes in low- and middle-income countries: systematic review and meta-analysis of randomised trials",
  "uid": "58a49e73-60c7-5aa5-883c-a640241966e1"
}