dc.contributor.author | Guthrie, Brandon L | |
dc.contributor.author | Choi, Robert Y | |
dc.contributor.author | Liu, Amy Y | |
dc.contributor.author | Mackelprang, Romel D | |
dc.contributor.author | Rositch, Anne F | |
dc.contributor.author | Bosire, Rose | |
dc.contributor.author | Manyara, Lucy | |
dc.contributor.author | Gatuguta, Anne | |
dc.contributor.author | Kiarie, James N | |
dc.contributor.author | Farquhar, Carey | |
dc.date.accessioned | 2013-04-16T07:47:44Z | |
dc.date.available | 2013-04-16T07:47:44Z | |
dc.date.issued | 2011 | |
dc.identifier.citation | J Acquir Immune Defic Syndr. 2011 November 1; 58(3): e87–e93 | en |
dc.identifier.uri | http://www.ncbi.nlm.nih.gov/pubmed/21826010 | |
dc.identifier.uri | http://erepository.uonbi.ac.ke:8080/xmlui/handle/123456789/16076 | |
dc.description | Full text | en |
dc.description.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 PEPFAR-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 (HR=0.49, p< 0.001). Compared to 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 a 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 |
dc.language.iso | en | en |
dc.subject | HIV | en |
dc.subject | Discordant couples | en |
dc.subject | Serodiscordant | en |
dc.subject | Antiretroviral | en |
dc.title | Barriers to Antiretroviral Initiation in HIV-1-Discordant Couples | en |
dc.type | Article | en |
local.publisher | Department of Obstetrics and Gynaecology | en |
local.publisher | Institute of Tropical and Infectious Diseases | en |