Continuum in HIV care from entry to ART initiation in rural KwaZulu‐Natal, South Africa. Issue 6 (21st March 2014)

• Record Type: Journal Article
• Authors: Plazy, Mélanie; Dray‐Spira, Rosemary; Orne‐Gliemann, Joanna; Dabis, François; Newell, Marie‐Louise
• Is Part Of: Tropical medicine & international health. Volume 19:Issue 6(2014:Jun.)
• Page Start: 680
• Page End: 689
• Publication Date: 2014-03-21
• Subjects: Tropical medicine -- Periodicals; Public health -- Periodicals; 616.988
• DOI: 10.1111/tmi.12301
• Languages: English
• ISSNs: 1360-2276

Abstract

<abstract abstract-type="main" id="tmi12301-abs-0001"> <title>Abstract</title> <sec id="tmi12301-sec-0001" sec-type="section"> <title>Objective</title> <p>To quantify time from entry in HIV care until Antiretroviral therapy (ART) initiation and identify factors associated with ART initiation in rural KwaZulu‐Natal, South Africa.</p> </sec> <sec id="tmi12301-sec-0002" sec-type="section"> <title>Methods</title> <p>Adults ≥16 years entering the decentralised Hlabisa ART programme between 2007 and 2011 were followed until June 2013. Median survival times to ART initiation from date of programme entry and from date of ART eligibility were estimated with Kaplan–Meier methods. Associated factors were evaluated in Cox regressions, censoring for deaths.</p> </sec> <sec id="tmi12301-sec-0003" sec-type="section"> <title>Results</title> <p>Of 37 749 adults (71.6% female), 17 638 (46.7%) initiated ART. Nearly half (46.9%) met the CD4 criteria for treatment eligibility at programme entry. Among the 20 039 individuals not yet ART‐eligible at entry, only 62.5% were retained in care with at least one further CD4 measurement, of whom 6688 subsequently became ART‐eligible. Overall, 65.5% of the 24 398 ART‐eligible individuals initiated ART over the study period. ART initiation was more likely in women (<italic>P</italic> < 0.001), in individuals ≥ 25 years old (<italic>P</italic> < 0.001) and in patients with low CD4 count (<italic>P</italic> < 0.001). Patients who became eligible during follow up were significantly more likely to initiate ART than those eligible at programme entry (72.6% <italic>vs</italic>. 62.9%, Adjusted Hazard Ratio = 1.46; 95% Confidence Interval [1.41–1.51]), adjusting for sex, age, year and CD4 count at eligibility.</p> </sec> <sec id="tmi12301-sec-0004" sec-type="section"> <title>Conclusions</title> <p>In this rural programme, continuation of care remains challenging, especially in men and younger adults. ART initiation is more likely in those engaged prior eligibility than in those entering HIV care only late in their HIV disease.</p> </sec> </abstract>