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Barriers to Antiretroviral Initiation in HIV-1- Discordant Couples

Publication year: 
Author (s): 
Brandon L. Guthrie [et al.]
Publication details: 
London, Lippincott Williams and Wilkins, 2011
Publication in: 
J Acquir Immune Defic Syndr  Volume 58, Number 3, November 1, 2011

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 followup.
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).