Barriers to antiretroviral initiation in HIV-1-discordant couples.
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Date
2011-11-01
Authors
Gatuguta, A.
Guthrie, B. L.
Choi, R. Y.
Liu, A. Y.
Mackelprang, R. D.
Rositch, A. F.
Bosire, R.
Manyara, L.
Kiarie, J. N.
Farquhar, C.
Journal Title
Journal ISSN
Volume Title
Publisher
JAIDS Journal of Acquired Immune Deficiency Syndromes
Abstract
BACKGROUND:
In Kenya and much of sub-Saharan Africa, nearly half of all couples affected by HIV are discordant. Antiretroviral therapy (ART) slows disease progression in HIV-1-infected individuals and reduces transmission to uninfected partners. We examined time to ART initiation and factors associated with delayed initiation in HIV-1-discordant couples in Nairobi.
METHODS:
HIV-1-discordant couples were enrolled and followed quarterly for up to 2 years. Clinical staff administered questionnaires and conducted viral loads and CD4 counts. Participants with a CD4 count meeting ART criteria were referred to a nearby US President's Emergency Plan for AIDS Relief-funded treatment center. Barriers to ART initiation among participants with a CD4 count eligible for ART were assessed by Cox regression.
RESULTS:
Of 439 HIV-1-infected participants (63.6% females and 36.4% males), 146 met CD4 count criteria for ART during follow-up. Median time from meeting CD4 criteria until ART initiation was 8.9 months, with 42.0% of eligible participants on ART by 6 months and 63.4% on ART by 1 year. The CD4 count at the time of eligibility was inversely associated with time to ART initiation (hazard ratio = 0.49, P < 0.001). Compared with homeowners, those paying higher rents started ART 48% more slowly (P = 0.062) and those paying lower rents started 71% more slowly (P = 0.002).
CONCLUSIONS:
Despite access to regular health care, referrals to treatment centers, and free access to ART, over one-third of participants with an eligible CD4 count had not started ART within 1 year. Factors of lower socioeconomic status may slow ART initiation, and targeted approaches are needed to avoid delays in treatment initiation.
Description
doi: 10.1097/QAI.0b013e31822f064e.
Keywords
antiretroviral, ART, HAART, HIV, discordant couples, serodiscordant
Citation
J Acquir Immune Defic Syndr Volume 58, Number 3, November 1, 2011