Delayed ART initiation in “Test and Treat era” and its associated factors among adults receiving antiretroviral therapy at public health institutions in Northwest Ethiopia: A multicenter cross-sectional study

BACKGROUND: Antiretroviral therapy (ART) has shown promising effects on the reduction of new HIV infection as well as HIV-related morbidity and mortality. In order to boost the effect of ART on ending HIV epidemics by 2030, the World Health Organization (WHO) indeed introduced a universal test and treat strategy in 2015 that recommends rapid (within seven days) initiation of ART for all HIV-positive patients. However, in low-income countries, a substantial number of HIV-positive patients were not enrolled in time, and information on delayed ART initiation status in Ethiopia is limited. METHOD: A multicenter cross-sectional study was conducted on 400 HIV-positive adults receiving ART at public health institutions in Bahir Dar city, Northwest Ethiopia. A structured checklist was used to extract data from the patient’s medical record. Data was entered into Epi-data version 4.6 and exported to SPSS version 26 for further analysis. Both simple and multivariable binary logistic regressions were executed, and variables with a p-value < 0.05 in the final model were considered significant predictors of delayed ART initiation. RESULTS: The magnitude of delayed ART initiation was 39% (95% CI: 34%–44%). Being male [Adjusted odds ratio(AOR) = 1.99, 95%CI:1.3–3.2], having opportunistic infections (OIs) [AOR = 2.50, 95%CI:1.4–4.6], having other chronic diseases [AOR = 3.70,95%CI:1.7–8.3], substance abuse [AOR = 3.79, 95%CI: 1.9–7.4], having ambulatory functional status [AOR = 5.38, 95%CI: 1.4–9.6] and didn’t have other HIV-positive family member [AOR = 1.85, 95%CI: 1.2–2.9] increases the odds of delayed ART initiation. CONCLUSION AND RECOMMENDATION: The burden of delayed ART initiation is found to be high. The presence of OIs and other chronic problems, substance abuse, ambulatory functional status, being male, and not having other HIV-positive family members were identified as significant predictors of delayed ART initiation. Special emphasis needs to be considered for those individuals with the identified risk factors.