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Publication Details
AFRICAN RESEARCH NEXUS
SHINING A SPOTLIGHT ON AFRICAN RESEARCH
medicine
Barriers to antiretroviral initiation in HIV-1-discordant couples
Journal of Acquired Immune Deficiency Syndromes, Volume 58, No. 3, Year 2011
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Description
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. © 2011 Lippincott Williams & Wilkins.
Authors & Co-Authors
Guthrie, Brandon L.
United States, Seattle
University of Washington
Choi, Robert Y.
United States, Seattle
University of Washington
Liu, Amy Y.
United States, Seattle
University of Washington
MacKelprang, Romel D.
United States, Seattle
University of Washington
Rositch, Anne F.
United States, Raleigh
The University of North Carolina System
Bosire, Rose Kerubo
Kenya, Nairobi
Kenya Medical Research Institute
Manyara, Lucy
Kenya, Nairobi
Kenya Medical Training College
Gatuguta, Ann
Kenya, Nairobi
Kenyatta University
Kiarie, James Njogu
Kenya, Nairobi
University of Nairobi
Kenya, Nairobi
Kenyatta National Hospital
Farquhar, Carey
United States, Seattle
University of Washington
Statistics
Citations: 31
Authors: 10
Affiliations: 7
Identifiers
Doi:
10.1097/QAI.0b013e31822f064e
ISSN:
15254135
Research Areas
Environmental
Health System And Policy
Infectious Diseases
Study Design
Cohort Study
Study Locations
Kenya
Participants Gender
Female