Barriers to antiretroviral initiation in HIV-1-discordant couples.

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dc.contributor.authorGatuguta, A.
dc.contributor.authorGuthrie, B. L.
dc.contributor.authorChoi, R. Y.
dc.contributor.authorLiu, A. Y.
dc.contributor.authorMackelprang, R. D.
dc.contributor.authorRositch, A. F.
dc.contributor.authorBosire, R.
dc.contributor.authorManyara, L.
dc.contributor.authorKiarie, J. N.
dc.contributor.authorFarquhar, C.
dc.date.accessioned2014-04-22T12:48:53Z
dc.date.available2014-04-22T12:48:53Z
dc.date.issued2011-11-01
dc.descriptiondoi: 10.1097/QAI.0b013e31822f064e.en_US
dc.description.abstractBACKGROUND: 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.en_US
dc.identifier.citationJ Acquir Immune Defic Syndr Volume 58, Number 3, November 1, 2011en_US
dc.identifier.issn1525-4135
dc.identifier.issn1944-7884
dc.identifier.urihttp://ir-library.ku.ac.ke/handle/123456789/9408
dc.language.isoenen_US
dc.publisherJAIDS Journal of Acquired Immune Deficiency Syndromesen_US
dc.subjectantiretroviralen_US
dc.subjectARTen_US
dc.subjectHAARTen_US
dc.subjectHIVen_US
dc.subjectdiscordant couplesen_US
dc.subjectserodiscordanten_US
dc.titleBarriers to antiretroviral initiation in HIV-1-discordant couples.en_US
dc.typeArticleen_US
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