Prevalence and factors associated with delayed antiretroviral therapy initiation among adults with HIV in Alebtong district, Northern Uganda: A facility-based study

Globally, an estimated 36.7 million people were living with HIV (PLWH) and of these, 2.1 million were newly infected and 1.1 million died of AIDS in 2015. By 2016, only 67% of adults eligible for ART were enrolled in ART in Uganda. Delayed ART initiation has been shown to contribute to the continued transmission of HIV as well as to higher morbidity and mortality among persons living with HIV. Our study examined the prevalence and factors associated with delayed ART initiation among adults with HIV in Alebtong district, Northern Uganda. A cross-sectional study involving 432 adults living with HIV was conducted between March and June 2018 in Alebtong district. Quantitative data were collected using interviewer-administered questionnaires and desk reviews using a data extraction tool. A binary logistic regression using a hierarchical modelling technique was used at the multivariable level to determine associations at a 95% confidence interval and p<0.05 using SPSS Statistics software version 23.0. Overall, 432 participants were enrolled in the study, of whom 18.1% (78/432) had delayed ART initiation. After final adjustment, our key findings showed a significantly lower odds of delayed ART initiation among older respondents (aOR = 0.35, 95% CI: 0.16–0.76); adherence to HIV clinic appointments, (aOR = 0.06, 95% CI: 0.02–0.15); and linkage to the HIV clinic the same day HIV test was conducted (aOR = 0.21, 95% CI: 0.08–0.55). However, a significantly higher odds of delayed ART initiation was observed among those whose cultures do not support the use of ART (aOR = 10.62, 95% CI: 3.04–32.08). Reducing delayed ART initiation in the district requires strengthening the involvement of adolescents and young people in the HIVAIDS programming, scaling up the implementation of the same-day ART initiation policy, and addressing negative cultural beliefs affecting early ART initiation in the district.