Predictors of antiretroviral therapy initiation in eThekwini (Durban), South Africa: Findings from a prospective cohort study

Despite expanded antiretroviral therapy (ART) eligibility in South Africa, many people diagnosed with HIV do not initiate ART promptly, yet understanding of the reasons is limited. Using data from an 8-month prospective cohort interview study of women and men newly-diagnosed with HIV in three public...

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Autores principales: Sy, Karla Therese L., Tariq, Shema, Ramjee, Gita, Blanchard, Kelly, Leu, Cheng-Shiun, Kelvin, Elizabeth A., Exner, Theresa M., Gandhi, Anisha D., Lince-Deroche, Naomi, Mantell, Joanne E., O’Sullivan, Lucia F., Hoffman, Susie
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Public Library of Science 2021
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7895397/
https://www.ncbi.nlm.nih.gov/pubmed/33606712
http://dx.doi.org/10.1371/journal.pone.0246744
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author Sy, Karla Therese L.
Tariq, Shema
Ramjee, Gita
Blanchard, Kelly
Leu, Cheng-Shiun
Kelvin, Elizabeth A.
Exner, Theresa M.
Gandhi, Anisha D.
Lince-Deroche, Naomi
Mantell, Joanne E.
O’Sullivan, Lucia F.
Hoffman, Susie
author_facet Sy, Karla Therese L.
Tariq, Shema
Ramjee, Gita
Blanchard, Kelly
Leu, Cheng-Shiun
Kelvin, Elizabeth A.
Exner, Theresa M.
Gandhi, Anisha D.
Lince-Deroche, Naomi
Mantell, Joanne E.
O’Sullivan, Lucia F.
Hoffman, Susie
author_sort Sy, Karla Therese L.
collection PubMed
description Despite expanded antiretroviral therapy (ART) eligibility in South Africa, many people diagnosed with HIV do not initiate ART promptly, yet understanding of the reasons is limited. Using data from an 8-month prospective cohort interview study of women and men newly-diagnosed with HIV in three public-sector primary care clinics in the eThekwini (Durban) region, South Africa, 2010–2014, we examined if theoretically-relevant social-structural, social-cognitive, psychosocial, and health status indicators were associated with time to ART initiation. Of 459 diagnosed, 350 returned to the clinic for their CD4+ test results (linkage); 153 (33.3%) were ART-eligible according to treatment criteria at the time; 115 (75.2% of those eligible) initiated ART (median = 12.86 weeks [95% CI: 9.75, 15.97] after linkage). In adjusted Cox proportional hazard models, internalized stigma was associated with a 65% decrease in the rate of ART initiation (Adjusted hazard ratio [AHR] 0.35, 95% CI: 0.19–0.80) during the period less than four weeks after linkage to care, but not four or more weeks after linkage to care, suggesting that stigma-reduction interventions implemented shortly after diagnosis may accelerate ART uptake. As reported by others, older age was associated with more rapid ART initiation (AHR for 1-year age increase: 1.04, 95% CI: 1.01–1.07) and higher CD4+ cell count (≥300μL vs. <150μL) was associated with a lower rate of initiation (AHR 0.38, 95% CI: 0.19–0.80). Several other factors that were assessed prior to diagnosis, including stronger belief in traditional medicine, higher endorsement of stigma toward people living with HIV, food insecurity, and higher psychological distress, were found to be in the expected direction of association with ART initiation, but confidence intervals were wide and could not exclude a null finding.
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spelling pubmed-78953972021-03-01 Predictors of antiretroviral therapy initiation in eThekwini (Durban), South Africa: Findings from a prospective cohort study Sy, Karla Therese L. Tariq, Shema Ramjee, Gita Blanchard, Kelly Leu, Cheng-Shiun Kelvin, Elizabeth A. Exner, Theresa M. Gandhi, Anisha D. Lince-Deroche, Naomi Mantell, Joanne E. O’Sullivan, Lucia F. Hoffman, Susie PLoS One Research Article Despite expanded antiretroviral therapy (ART) eligibility in South Africa, many people diagnosed with HIV do not initiate ART promptly, yet understanding of the reasons is limited. Using data from an 8-month prospective cohort interview study of women and men newly-diagnosed with HIV in three public-sector primary care clinics in the eThekwini (Durban) region, South Africa, 2010–2014, we examined if theoretically-relevant social-structural, social-cognitive, psychosocial, and health status indicators were associated with time to ART initiation. Of 459 diagnosed, 350 returned to the clinic for their CD4+ test results (linkage); 153 (33.3%) were ART-eligible according to treatment criteria at the time; 115 (75.2% of those eligible) initiated ART (median = 12.86 weeks [95% CI: 9.75, 15.97] after linkage). In adjusted Cox proportional hazard models, internalized stigma was associated with a 65% decrease in the rate of ART initiation (Adjusted hazard ratio [AHR] 0.35, 95% CI: 0.19–0.80) during the period less than four weeks after linkage to care, but not four or more weeks after linkage to care, suggesting that stigma-reduction interventions implemented shortly after diagnosis may accelerate ART uptake. As reported by others, older age was associated with more rapid ART initiation (AHR for 1-year age increase: 1.04, 95% CI: 1.01–1.07) and higher CD4+ cell count (≥300μL vs. <150μL) was associated with a lower rate of initiation (AHR 0.38, 95% CI: 0.19–0.80). Several other factors that were assessed prior to diagnosis, including stronger belief in traditional medicine, higher endorsement of stigma toward people living with HIV, food insecurity, and higher psychological distress, were found to be in the expected direction of association with ART initiation, but confidence intervals were wide and could not exclude a null finding. Public Library of Science 2021-02-19 /pmc/articles/PMC7895397/ /pubmed/33606712 http://dx.doi.org/10.1371/journal.pone.0246744 Text en © 2021 Sy et al http://creativecommons.org/licenses/by/4.0/ This is an open access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/4.0/) , which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.
spellingShingle Research Article
Sy, Karla Therese L.
Tariq, Shema
Ramjee, Gita
Blanchard, Kelly
Leu, Cheng-Shiun
Kelvin, Elizabeth A.
Exner, Theresa M.
Gandhi, Anisha D.
Lince-Deroche, Naomi
Mantell, Joanne E.
O’Sullivan, Lucia F.
Hoffman, Susie
Predictors of antiretroviral therapy initiation in eThekwini (Durban), South Africa: Findings from a prospective cohort study
title Predictors of antiretroviral therapy initiation in eThekwini (Durban), South Africa: Findings from a prospective cohort study
title_full Predictors of antiretroviral therapy initiation in eThekwini (Durban), South Africa: Findings from a prospective cohort study
title_fullStr Predictors of antiretroviral therapy initiation in eThekwini (Durban), South Africa: Findings from a prospective cohort study
title_full_unstemmed Predictors of antiretroviral therapy initiation in eThekwini (Durban), South Africa: Findings from a prospective cohort study
title_short Predictors of antiretroviral therapy initiation in eThekwini (Durban), South Africa: Findings from a prospective cohort study
title_sort predictors of antiretroviral therapy initiation in ethekwini (durban), south africa: findings from a prospective cohort study
topic Research Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7895397/
https://www.ncbi.nlm.nih.gov/pubmed/33606712
http://dx.doi.org/10.1371/journal.pone.0246744
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