Barriers to Antiretroviral Initiation in HIV-1-Discordant Couples
Identifieur interne : 001167 ( Pmc/Corpus ); précédent : 001166; suivant : 001168Barriers to Antiretroviral Initiation in HIV-1-Discordant Couples
Auteurs : Brandon L. Guthrie ; Robert Y. Choi ; Amy Y. Liu ; Romel D. Mackelprang ; Anne F. Rositch ; Rose Bosire ; Lucy Manyara ; Anne Gatuguta ; James N. Kiarie ; Carey FarquharSource :
- Journal of acquired immune deficiency syndromes (1999) [ 1525-4135 ] ; 2011.
Abstract
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.
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 PEPFAR-funded treatment center. Barriers to ART initiation among participants with a CD4 count eligible for ART were assessed by Cox regression.
Of 439 HIV-1-infected participants (63.6% females and 36.4% males) 146 met CD4 count criteria for ART during follow-up. 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 (HR=0.49, p< 0.001). Compared to 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).
Despite access to regular health care, referrals to treatment centers, and free access to ART, over a third of participants with an eligible CD4 count had not started ART within 1 year. Factors of lower socioeconomic status may slow ART initiation and targeted approaches are needed to avoid delays in treatment initiation.
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DOI: 10.1097/QAI.0b013e31822f064e
PubMed: 21826010
PubMed Central: 3202340
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<record><TEI><teiHeader><fileDesc><titleStmt><title xml:lang="en">Barriers to Antiretroviral Initiation in HIV-1-Discordant Couples</title><author><name sortKey="Guthrie, Brandon L" sort="Guthrie, Brandon L" uniqKey="Guthrie B" first="Brandon L." last="Guthrie">Brandon L. Guthrie</name><affiliation><nlm:aff id="A1">Department of Epidemiology, University of Washington, Seattle, WA</nlm:aff></affiliation></author><author><name sortKey="Choi, Robert Y" sort="Choi, Robert Y" uniqKey="Choi R" first="Robert Y." last="Choi">Robert Y. Choi</name><affiliation><nlm:aff id="A2">Department of Medicine, University of Washington, Seattle, WA</nlm:aff></affiliation></author><author><name sortKey="Liu, Amy Y" sort="Liu, Amy Y" uniqKey="Liu A" first="Amy Y." last="Liu">Amy Y. Liu</name><affiliation><nlm:aff id="A1">Department of Epidemiology, University of Washington, Seattle, WA</nlm:aff></affiliation></author><author><name sortKey="Mackelprang, Romel D" sort="Mackelprang, Romel D" uniqKey="Mackelprang R" first="Romel D." last="Mackelprang">Romel D. Mackelprang</name><affiliation><nlm:aff id="A1">Department of Epidemiology, University of Washington, Seattle, WA</nlm:aff></affiliation></author><author><name sortKey="Rositch, Anne F" sort="Rositch, Anne F" uniqKey="Rositch A" first="Anne F." last="Rositch">Anne F. Rositch</name><affiliation><nlm:aff id="A4">Department of Epidemiology, University of North Carolina</nlm:aff></affiliation></author><author><name sortKey="Bosire, Rose" sort="Bosire, Rose" uniqKey="Bosire R" first="Rose" last="Bosire">Rose Bosire</name><affiliation><nlm:aff id="A5">Center for Public Health Research, Kenya Medical Research Institute, Nairobi, Kenya</nlm:aff></affiliation></author><author><name sortKey="Manyara, Lucy" sort="Manyara, Lucy" uniqKey="Manyara L" first="Lucy" last="Manyara">Lucy Manyara</name><affiliation><nlm:aff id="A6">Department of Ophthalmology, Kenya Medical Training College, Nairobi, Kenya</nlm:aff></affiliation></author><author><name sortKey="Gatuguta, Anne" sort="Gatuguta, Anne" uniqKey="Gatuguta A" first="Anne" last="Gatuguta">Anne Gatuguta</name><affiliation><nlm:aff id="A7">Department of Public Health, Kenyatta University, Nairobi, Kenya</nlm:aff></affiliation></author><author><name sortKey="Kiarie, James N" sort="Kiarie, James N" uniqKey="Kiarie J" first="James N." last="Kiarie">James N. Kiarie</name><affiliation><nlm:aff id="A8">Department of Obstetrics and Gynaecology, University of Nairobi, Nairobi, Kenya</nlm:aff></affiliation><affiliation><nlm:aff id="A9">Institute of Tropical and Infectious Diseases, University of Nairobi, Nairobi, Kenya</nlm:aff></affiliation><affiliation><nlm:aff id="A10">Kenyatta National Hospital, Nairobi, Kenya</nlm:aff></affiliation></author><author><name sortKey="Farquhar, Carey" sort="Farquhar, Carey" uniqKey="Farquhar C" first="Carey" last="Farquhar">Carey Farquhar</name><affiliation><nlm:aff id="A1">Department of Epidemiology, University of Washington, Seattle, WA</nlm:aff></affiliation><affiliation><nlm:aff id="A4">Department of Epidemiology, University of North Carolina</nlm:aff></affiliation><affiliation><nlm:aff id="A3">Department of Global Health, University of Washington, Seattle, WA</nlm:aff></affiliation></author></titleStmt><publicationStmt><idno type="wicri:source">PMC</idno><idno type="pmid">21826010</idno><idno type="pmc">3202340</idno><idno type="url">http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3202340</idno><idno type="RBID">PMC:3202340</idno><idno type="doi">10.1097/QAI.0b013e31822f064e</idno><date when="2011">2011</date><idno type="wicri:Area/Pmc/Corpus">001167</idno><idno type="wicri:explorRef" wicri:stream="Pmc" wicri:step="Corpus" wicri:corpus="PMC">001167</idno></publicationStmt><sourceDesc><biblStruct><analytic><title xml:lang="en" level="a" type="main">Barriers to Antiretroviral Initiation in HIV-1-Discordant Couples</title><author><name sortKey="Guthrie, Brandon L" sort="Guthrie, Brandon L" uniqKey="Guthrie B" first="Brandon L." last="Guthrie">Brandon L. Guthrie</name><affiliation><nlm:aff id="A1">Department of Epidemiology, University of Washington, Seattle, WA</nlm:aff></affiliation></author><author><name sortKey="Choi, Robert Y" sort="Choi, Robert Y" uniqKey="Choi R" first="Robert Y." last="Choi">Robert Y. Choi</name><affiliation><nlm:aff id="A2">Department of Medicine, University of Washington, Seattle, WA</nlm:aff></affiliation></author><author><name sortKey="Liu, Amy Y" sort="Liu, Amy Y" uniqKey="Liu A" first="Amy Y." last="Liu">Amy Y. Liu</name><affiliation><nlm:aff id="A1">Department of Epidemiology, University of Washington, Seattle, WA</nlm:aff></affiliation></author><author><name sortKey="Mackelprang, Romel D" sort="Mackelprang, Romel D" uniqKey="Mackelprang R" first="Romel D." last="Mackelprang">Romel D. Mackelprang</name><affiliation><nlm:aff id="A1">Department of Epidemiology, University of Washington, Seattle, WA</nlm:aff></affiliation></author><author><name sortKey="Rositch, Anne F" sort="Rositch, Anne F" uniqKey="Rositch A" first="Anne F." last="Rositch">Anne F. Rositch</name><affiliation><nlm:aff id="A4">Department of Epidemiology, University of North Carolina</nlm:aff></affiliation></author><author><name sortKey="Bosire, Rose" sort="Bosire, Rose" uniqKey="Bosire R" first="Rose" last="Bosire">Rose Bosire</name><affiliation><nlm:aff id="A5">Center for Public Health Research, Kenya Medical Research Institute, Nairobi, Kenya</nlm:aff></affiliation></author><author><name sortKey="Manyara, Lucy" sort="Manyara, Lucy" uniqKey="Manyara L" first="Lucy" last="Manyara">Lucy Manyara</name><affiliation><nlm:aff id="A6">Department of Ophthalmology, Kenya Medical Training College, Nairobi, Kenya</nlm:aff></affiliation></author><author><name sortKey="Gatuguta, Anne" sort="Gatuguta, Anne" uniqKey="Gatuguta A" first="Anne" last="Gatuguta">Anne Gatuguta</name><affiliation><nlm:aff id="A7">Department of Public Health, Kenyatta University, Nairobi, Kenya</nlm:aff></affiliation></author><author><name sortKey="Kiarie, James N" sort="Kiarie, James N" uniqKey="Kiarie J" first="James N." last="Kiarie">James N. Kiarie</name><affiliation><nlm:aff id="A8">Department of Obstetrics and Gynaecology, University of Nairobi, Nairobi, Kenya</nlm:aff></affiliation><affiliation><nlm:aff id="A9">Institute of Tropical and Infectious Diseases, University of Nairobi, Nairobi, Kenya</nlm:aff></affiliation><affiliation><nlm:aff id="A10">Kenyatta National Hospital, Nairobi, Kenya</nlm:aff></affiliation></author><author><name sortKey="Farquhar, Carey" sort="Farquhar, Carey" uniqKey="Farquhar C" first="Carey" last="Farquhar">Carey Farquhar</name><affiliation><nlm:aff id="A1">Department of Epidemiology, University of Washington, Seattle, WA</nlm:aff></affiliation><affiliation><nlm:aff id="A4">Department of Epidemiology, University of North Carolina</nlm:aff></affiliation><affiliation><nlm:aff id="A3">Department of Global Health, University of Washington, Seattle, WA</nlm:aff></affiliation></author></analytic><series><title level="j">Journal of acquired immune deficiency syndromes (1999)</title><idno type="ISSN">1525-4135</idno><idno type="eISSN">1944-7884</idno><imprint><date when="2011">2011</date></imprint></series></biblStruct></sourceDesc></fileDesc><profileDesc><textClass></textClass></profileDesc></teiHeader><front><div type="abstract" xml:lang="en"><sec id="S1"><title>BACKGROUND</title><p id="P1">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.</p></sec><sec sec-type="methods" id="S2"><title>METHODS</title><p id="P2">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 PEPFAR-funded treatment center. Barriers to ART initiation among participants with a CD4 count eligible for ART were assessed by Cox regression.</p></sec><sec id="S3"><title>RESULTS</title><p id="P3">Of 439 HIV-1-infected participants (63.6% females and 36.4% males) 146 met CD4 count criteria for ART during follow-up. 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 (HR=0.49, p< 0.001). Compared to 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).</p></sec><sec id="S4"><title>CONCLUSIONS</title><p id="P4">Despite access to regular health care, referrals to treatment centers, and free access to ART, over a third of participants with an eligible CD4 count had not started ART within 1 year. Factors of lower socioeconomic status may slow ART initiation and targeted approaches are needed to avoid delays in treatment initiation.</p></sec></div></front></TEI><pmc article-type="research-article" xml:lang="en"><pmc-comment>The publisher of this article does not allow downloading of the full text in XML form.</pmc-comment>
<pmc-dir>properties manuscript</pmc-dir>
<front><journal-meta><journal-id journal-id-type="nlm-journal-id">100892005</journal-id><journal-id journal-id-type="pubmed-jr-id">21821</journal-id><journal-id journal-id-type="nlm-ta">J Acquir Immune Defic Syndr</journal-id><journal-title-group><journal-title>Journal of acquired immune deficiency syndromes (1999)</journal-title></journal-title-group><issn pub-type="ppub">1525-4135</issn><issn pub-type="epub">1944-7884</issn></journal-meta><article-meta><article-id pub-id-type="pmid">21826010</article-id><article-id pub-id-type="pmc">3202340</article-id><article-id pub-id-type="doi">10.1097/QAI.0b013e31822f064e</article-id><article-id pub-id-type="manuscript">NIHMS319979</article-id><article-categories><subj-group subj-group-type="heading"><subject>Article</subject></subj-group></article-categories><title-group><article-title>Barriers to Antiretroviral Initiation in HIV-1-Discordant Couples</article-title></title-group><contrib-group><contrib contrib-type="author"><name><surname>Guthrie</surname><given-names>Brandon L.</given-names></name><degrees>PhD</degrees><xref rid="A1" ref-type="aff">*</xref></contrib><contrib contrib-type="author"><name><surname>Choi</surname><given-names>Robert Y.</given-names></name><degrees>MD, MIA, MPH</degrees><xref rid="A2" ref-type="aff">†</xref></contrib><contrib contrib-type="author"><name><surname>Liu</surname><given-names>Amy Y.</given-names></name><degrees>MPH</degrees><xref rid="A1" ref-type="aff">*</xref></contrib><contrib contrib-type="author"><name><surname>Mackelprang</surname><given-names>Romel D.</given-names></name><degrees>PhD</degrees><xref rid="A1" ref-type="aff">*</xref></contrib><contrib contrib-type="author"><name><surname>Rositch</surname><given-names>Anne F.</given-names></name><degrees>MPH</degrees><xref rid="A4" ref-type="aff">‡</xref></contrib><contrib contrib-type="author"><name><surname>Bosire</surname><given-names>Rose</given-names></name><degrees>MBChB, MPH</degrees><xref rid="A5" ref-type="aff">¶</xref></contrib><contrib contrib-type="author"><name><surname>Manyara</surname><given-names>Lucy</given-names></name><degrees>MBChB, MMed</degrees><xref rid="A6" ref-type="aff">↓</xref></contrib><contrib contrib-type="author"><name><surname>Gatuguta</surname><given-names>Anne</given-names></name><degrees>MBChB, MPH</degrees><xref rid="A7" ref-type="aff">#</xref></contrib><contrib contrib-type="author"><name><surname>Kiarie</surname><given-names>James N.</given-names></name><degrees>MBChB, MMed, MPH</degrees><xref rid="A8" ref-type="aff">£</xref><xref rid="A9" ref-type="aff">∥</xref><xref rid="A10" ref-type="aff">⇑</xref></contrib><contrib contrib-type="author"><name><surname>Farquhar</surname><given-names>Carey</given-names></name><degrees>MD, MPH</degrees><xref rid="A1" ref-type="aff">*</xref><xref rid="A4" ref-type="aff">‡</xref><xref rid="A3" ref-type="aff">§</xref></contrib></contrib-group><aff id="A1"><label>*</label>Department of Epidemiology, University of Washington, Seattle, WA</aff><aff id="A2"><label>†</label>Department of Medicine, University of Washington, Seattle, WA</aff><aff id="A3"><label>§</label>Department of Global Health, University of Washington, Seattle, WA</aff><aff id="A4"><label>‡</label>Department of Epidemiology, University of North Carolina</aff><aff id="A5"><label>¶</label>Center for Public Health Research, Kenya Medical Research Institute, Nairobi, Kenya</aff><aff id="A6"><label>↓</label>Department of Ophthalmology, Kenya Medical Training College, Nairobi, Kenya</aff><aff id="A7"><label>#</label>Department of Public Health, Kenyatta University, Nairobi, Kenya</aff><aff id="A8"><label>£</label>Department of Obstetrics and Gynaecology, University of Nairobi, Nairobi, Kenya</aff><aff id="A9"><label>∥</label>Institute of Tropical and Infectious Diseases, University of Nairobi, Nairobi, Kenya</aff><aff id="A10"><label>⇑</label>Kenyatta National Hospital, Nairobi, Kenya</aff><author-notes><corresp id="FN1">Corresponding author: Brandon Guthrie, PhD, 325 Ninth Avenue, University of Washington Box 359909, Seattle, WA 98104-2499 USA, Telephone: (206) 265-2021 Fax: (206) 543-4818 <email>brguth@u.washington.edu</email></corresp></author-notes><pub-date pub-type="nihms-submitted"><day>6</day><month>10</month><year>2011</year></pub-date><pub-date pub-type="ppub"><day>1</day><month>11</month><year>2011</year></pub-date><pub-date pub-type="pmc-release"><day>1</day><month>11</month><year>2012</year></pub-date><volume>58</volume><issue>3</issue><fpage>e87</fpage><lpage>e93</lpage><abstract><sec id="S1"><title>BACKGROUND</title><p id="P1">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.</p></sec><sec sec-type="methods" id="S2"><title>METHODS</title><p id="P2">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 PEPFAR-funded treatment center. Barriers to ART initiation among participants with a CD4 count eligible for ART were assessed by Cox regression.</p></sec><sec id="S3"><title>RESULTS</title><p id="P3">Of 439 HIV-1-infected participants (63.6% females and 36.4% males) 146 met CD4 count criteria for ART during follow-up. 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 (HR=0.49, p< 0.001). Compared to 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).</p></sec><sec id="S4"><title>CONCLUSIONS</title><p id="P4">Despite access to regular health care, referrals to treatment centers, and free access to ART, over a third of participants with an eligible CD4 count had not started ART within 1 year. Factors of lower socioeconomic status may slow ART initiation and targeted approaches are needed to avoid delays in treatment initiation.</p></sec></abstract><kwd-group><kwd>HIV</kwd><kwd>discordant couples</kwd><kwd>serodiscordant</kwd><kwd>antiretroviral</kwd><kwd>ART</kwd><kwd>HAART</kwd></kwd-group><funding-group><award-group><funding-source country="United States">National Institute of Allergy and Infectious Diseases Extramural Activities : NIAID</funding-source><award-id>T32 AI007140-33 || AI</award-id></award-group><award-group><funding-source country="United States">National Institute of Allergy and Infectious Diseases Extramural Activities : NIAID</funding-source><award-id>T32 AI007140-32 || AI</award-id></award-group><award-group><funding-source country="United States">National Institute of Allergy and Infectious Diseases Extramural Activities : NIAID</funding-source><award-id>T32 AI007140-31 || AI</award-id></award-group><award-group><funding-source country="United States">National Institute of Allergy and Infectious Diseases Extramural Activities : NIAID</funding-source><award-id>R01 AI068431-04 || AI</award-id></award-group><award-group><funding-source country="United States">Fogarty International Center : FIC</funding-source><award-id>D43 TW000007-21 || TW</award-id></award-group></funding-group></article-meta></front></pmc></record>Pour manipuler ce document sous Unix (Dilib)
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