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Background Most countries have formally adopted the World Health Organization's 2015 recommendation of universal HIV treatment ('treat all'). However, there are few rigorous assessments of the real-world impact of treat all policies on antiretroviral treatment (ART) uptake across different contexts. Methods and findings We used longitudinal data for 814,603 patients enrolling in HIV care between 1 January 2004 and 10 July 2018 in 6 countries participating in the global International epidemiology Databases to Evaluate AIDS (IeDEA) consortium: Burundi (N = 11,176), Kenya (N = 179,941), Malawi (N = 84,558), Rwanda (N = 17,396), Uganda (N = 96,286), and Zambia (N = 425,246). Using a quasi-experimental regression discontinuity design, we assessed the change in the proportion initiating ART within 30 days of enrollment in HIV care (rapid ART initiation) after country-level adoption of the treat all policy. A modified Poisson model was used to identify factors associated with failure to initiate ART rapidly under treat all. In each of the 6 countries, over 60% of included patients were female, and median age at enrollment ranged from 32 to 36 years. In all countries studied, national adoption of treat all was associated with large increases in rapid ART initiation. Significant increases in rapid ART initiation immediately after treat all policy adoption were observed in Rwanda, from 44.4% to 78.9% of patients (34.5 percentage points [pp], 95% CI 27.2 to 41.7; p < 0.001), Kenya (25.7 pp, 95% CI 21.8 to 29.5; p < 0.001), Burundi (17.7 pp, 95% CI 6.5 to 28.9; p = 0.002), and Malawi (12.5 pp, 95% CI 7.5 to 17.5; p < 0.001), while no immediate increase was observed in Zambia (0.4 pp, 95% CI -2.9 to 3.8; p = 0.804) and Uganda (-4.2 pp, 95% CI -9.0 to 0.7; p = 0.090). The rate of rapid ART initiation accelerated sharply following treat all policy adoption in Malawi, Uganda, and Zambia; slowed in Kenya; and did not change in Rwanda and Burundi. In post hoc analyses restricted to patients enrolling under treat all, young adults (16-24 years) and men were at increased risk of not rapidly initiating ART (compared to older patients and women, respectively). However, rapid ART initiation following enrollment increased for all groups as more time elapsed since treat all policy adoption. Study limitations include incomplete data on potential ART eligibility criteria, such as clinical status, pregnancy, and enrollment CD4 count, which precluded the assessment of rapid ART initiation specifically among patients known to be eligible for ART before treat all. Conclusions Our analysis indicates that adoption of treat all policies had a strong effect on increasing rates of rapid ART initiation, and that these increases followed different trajectories across the 6 countries. Young adults and men still require additional attention to further improve rapid ART initiation., Author(s): Olga Tymejczyk 1,2,*, Ellen Brazier 1,2, Constantin T. Yiannoutsos 3, Michael Vinikoor 4,5, Monique van Lettow 6,7, Fred Nalugoda 8, Mark Urassa 9, Jean d'Amour Sinayobye 10, Peter F. [...]

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Objective: To determine the occurrence of lower genitourinary tract (LGUT) injury during hysterectomy for benign disease and identify risk factors for LGUT injury, with a specific focus on the effect of hysterectomy modality.Methods: We performed a retrospective cohort study of patients undergoing hysterectomy for benign disease from 2010 t o 2014 using the American College of Surgeons National Surgical Quality Improvement Program, a multi-institutional prospective registry that captures perioperative surgical outcomes. We identified the occurrence of concomitant cystoscopy and therapeutic urologic interventions including endoscopic ureteric stenting, ureteric repair, bladder repair, cystectomy, and urinary diversion as a proxy for LGUT injuries. Adjusted odds ratios and 95% confidence intervals were calculated using multivariate logistic regression.Results: We identified 101,021 patients treated with hysterectomy for benign disease: 18,610 (18.4%), 27,427 (27.2%), and 54,984 (54.4%) underwent vaginal, open, and laparoscopic hysterectomy, respectively. Cystoscopy was performed in 16,493 cases (16.3%). There were 2427 patients (2.4%) who underwent concomitant urologic intervention. Patients undergoing laparoscopic hysterectomy had increased occurrence of urologic intervention, excluding cystoscopy (adjusted odds ratio 1.47, 95% confidence interval 1.29-1.69), compared to vaginal hysterectomy; no differences were found between open and vaginal hysterectomy or laparoscopic and open hysterectomy. Larger uteri, a postoperative diagnosis of endometriosis, increasing comorbidity, and African American race were associated with an increased odd of urologic intervention whereas concomitant cystoscopy was associated with a decreased chance.Conclusion: The incidence of lower genitourinary tract intervention in benign hysterectomy is significant and may be higher than previously reported. Predisposing patient factors and operative technique are key risk factors. [ABSTRACT FROM AUTHOR]