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<record><TEI><teiHeader><fileDesc><titleStmt><title xml:lang="en">Program-level and contextual-level determinants of low-median CD4<sup>+</sup> cell count in cohorts of persons initiating ART in eight sub-Saharan African countries</title><author><name sortKey="Nash, Denis" sort="Nash, Denis" uniqKey="Nash D" first="Denis" last="Nash">Denis Nash</name><affiliation><nlm:aff id="A1">International Center for AIDS Care and Treatment Programs (ICAP), Columbia University Mailman School of Public Health, New York, New York USA</nlm:aff></affiliation><affiliation><nlm:aff id="A2">Department of Epidemiology, Columbia University Mailman School of Public Health, New York, New York USA</nlm:aff></affiliation><affiliation><nlm:aff id="A3">Epidemiology and Biostatistics Program, CUNY School of Public Health, Hunter College, New York, New York USA</nlm:aff></affiliation></author><author><name sortKey="Wu, Yingfeng" sort="Wu, Yingfeng" uniqKey="Wu Y" first="Yingfeng" last="Wu">Yingfeng Wu</name><affiliation><nlm:aff id="A1">International Center for AIDS Care and Treatment Programs (ICAP), Columbia University Mailman School of Public Health, New York, New York USA</nlm:aff></affiliation></author><author><name sortKey="Elul, Batya" sort="Elul, Batya" uniqKey="Elul B" first="Batya" last="Elul">Batya Elul</name><affiliation><nlm:aff id="A1">International Center for AIDS Care and Treatment Programs (ICAP), Columbia University Mailman School of Public Health, New York, New York USA</nlm:aff></affiliation><affiliation><nlm:aff id="A2">Department of Epidemiology, Columbia University Mailman School of Public Health, New York, New York USA</nlm:aff></affiliation></author><author><name sortKey="Hoos, David" sort="Hoos, David" uniqKey="Hoos D" first="David" last="Hoos">David Hoos</name><affiliation><nlm:aff id="A1">International Center for AIDS Care and Treatment Programs (ICAP), Columbia University Mailman School of Public Health, New York, New York USA</nlm:aff></affiliation><affiliation><nlm:aff id="A2">Department of Epidemiology, Columbia University Mailman School of Public Health, New York, New York USA</nlm:aff></affiliation></author><author><name sortKey="Sadr, Wafaa El" sort="Sadr, Wafaa El" uniqKey="Sadr W" first="Wafaa El" last="Sadr">Wafaa El Sadr</name><affiliation><nlm:aff id="A1">International Center for AIDS Care and Treatment Programs (ICAP), Columbia University Mailman School of Public Health, New York, New York USA</nlm:aff></affiliation><affiliation><nlm:aff id="A2">Department of Epidemiology, Columbia University Mailman School of Public Health, New York, New York USA</nlm:aff></affiliation></author></titleStmt><publicationStmt><idno type="wicri:source">PMC</idno><idno type="pmid">21750418</idno><idno type="pmc">3422866</idno><idno type="url">http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3422866</idno><idno type="RBID">PMC:3422866</idno><idno type="doi">10.1097/QAD.0b013e32834811b2</idno><date when="2011">2011</date><idno type="wicri:Area/Pmc/Corpus">001D42</idno><idno type="wicri:explorRef" wicri:stream="Pmc" wicri:step="Corpus" wicri:corpus="PMC">001D42</idno></publicationStmt><sourceDesc><biblStruct><analytic><title xml:lang="en" level="a" type="main">Program-level and contextual-level determinants of low-median CD4<sup>+</sup> cell count in cohorts of persons initiating ART in eight sub-Saharan African countries</title><author><name sortKey="Nash, Denis" sort="Nash, Denis" uniqKey="Nash D" first="Denis" last="Nash">Denis Nash</name><affiliation><nlm:aff id="A1">International Center for AIDS Care and Treatment Programs (ICAP), Columbia University Mailman School of Public Health, New York, New York USA</nlm:aff></affiliation><affiliation><nlm:aff id="A2">Department of Epidemiology, Columbia University Mailman School of Public Health, New York, New York USA</nlm:aff></affiliation><affiliation><nlm:aff id="A3">Epidemiology and Biostatistics Program, CUNY School of Public Health, Hunter College, New York, New York USA</nlm:aff></affiliation></author><author><name sortKey="Wu, Yingfeng" sort="Wu, Yingfeng" uniqKey="Wu Y" first="Yingfeng" last="Wu">Yingfeng Wu</name><affiliation><nlm:aff id="A1">International Center for AIDS Care and Treatment Programs (ICAP), Columbia University Mailman School of Public Health, New York, New York USA</nlm:aff></affiliation></author><author><name sortKey="Elul, Batya" sort="Elul, Batya" uniqKey="Elul B" first="Batya" last="Elul">Batya Elul</name><affiliation><nlm:aff id="A1">International Center for AIDS Care and Treatment Programs (ICAP), Columbia University Mailman School of Public Health, New York, New York USA</nlm:aff></affiliation><affiliation><nlm:aff id="A2">Department of Epidemiology, Columbia University Mailman School of Public Health, New York, New York USA</nlm:aff></affiliation></author><author><name sortKey="Hoos, David" sort="Hoos, David" uniqKey="Hoos D" first="David" last="Hoos">David Hoos</name><affiliation><nlm:aff id="A1">International Center for AIDS Care and Treatment Programs (ICAP), Columbia University Mailman School of Public Health, New York, New York USA</nlm:aff></affiliation><affiliation><nlm:aff id="A2">Department of Epidemiology, Columbia University Mailman School of Public Health, New York, New York USA</nlm:aff></affiliation></author><author><name sortKey="Sadr, Wafaa El" sort="Sadr, Wafaa El" uniqKey="Sadr W" first="Wafaa El" last="Sadr">Wafaa El Sadr</name><affiliation><nlm:aff id="A1">International Center for AIDS Care and Treatment Programs (ICAP), Columbia University Mailman School of Public Health, New York, New York USA</nlm:aff></affiliation><affiliation><nlm:aff id="A2">Department of Epidemiology, Columbia University Mailman School of Public Health, New York, New York USA</nlm:aff></affiliation></author></analytic><series><title level="j">AIDS (London, England)</title><idno type="ISSN">0269-9370</idno><idno type="eISSN">1473-5571</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>Objective</title><p id="P1">In sub-Saharan Africa, many patients initiate antiretroviral therapy (ART) at CD4<sup>+</sup> cell counts much lower than those recommended in national guidelines. We examined program-level and contextual-level factors associated with low median CD4<sup>+</sup> cell count at ART initiation in populations initiating ART.</p></sec><sec id="S2"><title>Design</title><p id="P2">Multilevel analysis of aggregate and program-level service delivery data.</p></sec><sec id="S3"><title>Methods</title><p id="P3">We examined data on 1690 cohorts of patients initiating ART during 2004–2008 in eight sub-Saharan African countries. Cohorts with median CD4<sup>+</sup> less than 111 cells/μl (the lowest quartile) were classified as having low median CD4<sup>+</sup> cell count at ART initiation. Cohort information was combined with time-updated program-level data and subnational contextual-level data, and analyzed using multilevel models.</p></sec><sec id="S4"><title>Results</title><p id="P4">The 1690 cohorts had median CD4<sup>+</sup> cell count of 136 cells/μl and included 121 504 patients initiating ART at 267 clinics. Program-level factors associated with low cohort median CD4<sup>+</sup> cell count included urban setting [adjusted odds ratio (AOR) 2.1; 95% confidence interval (CI) 1.3–3.3], lower provider-to-patient ratio (AOR 2.2; 95% CI 1.3–4.0), no PMTCT program (AOR 3.6; 95% CI 1.0–12.8), outreach services for ART patients only vs. both pre-ART and ART patients (AOR 2.4; 95% CI 1.5–3.9), fewer vs. more adherence support services (AOR 1.6; 95% CI 1.0–2.5), and smaller cohort size (AOR 2.5; 95% CI 1.4–4.5). Contextual-level factors associated with low cohort median CD4<sup>+</sup> cell count included initiating ART in areas where a lower proportion of the population heard of AIDS, tested for HIV recently, and a higher proportion believed ‘limiting themselves to one HIV-uninfected sexual partner reduces HIV risk’.</p></sec><sec id="S5"><title>Conclusion</title><p id="P5">Determinants of CD4<sup>+</sup>cell count at ART initiation in populations initiating ART operate at multiple levels. Structural interventions targeting points upstream from ART initiation along the continuum from infection to diagnosis to care engagement are needed.</p></sec></div></front></TEI><pmc article-type="research-article"><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">8710219</journal-id><journal-id journal-id-type="pubmed-jr-id">1493</journal-id><journal-id journal-id-type="nlm-ta">AIDS</journal-id><journal-id journal-id-type="iso-abbrev">AIDS</journal-id><journal-title-group><journal-title>AIDS (London, England)</journal-title></journal-title-group><issn pub-type="ppub">0269-9370</issn><issn pub-type="epub">1473-5571</issn></journal-meta><article-meta><article-id pub-id-type="pmid">21750418</article-id><article-id pub-id-type="pmc">3422866</article-id><article-id pub-id-type="doi">10.1097/QAD.0b013e32834811b2</article-id><article-id pub-id-type="manuscript">NIHMS391503</article-id><article-categories><subj-group subj-group-type="heading"><subject>Article</subject></subj-group></article-categories><title-group><article-title>Program-level and contextual-level determinants of low-median CD4<sup>+</sup> cell count in cohorts of persons initiating ART in eight sub-Saharan African countries</article-title></title-group><contrib-group><contrib contrib-type="author"><name><surname>Nash</surname><given-names>Denis</given-names></name><xref ref-type="aff" rid="A1">a</xref><xref ref-type="aff" rid="A2">b</xref><xref ref-type="aff" rid="A3">c</xref></contrib><contrib contrib-type="author"><name><surname>Wu</surname><given-names>Yingfeng</given-names></name><xref ref-type="aff" rid="A1">a</xref></contrib><contrib contrib-type="author"><name><surname>Elul</surname><given-names>Batya</given-names></name><xref ref-type="aff" rid="A1">a</xref><xref ref-type="aff" rid="A2">b</xref></contrib><contrib contrib-type="author"><name><surname>Hoos</surname><given-names>David</given-names></name><xref ref-type="aff" rid="A1">a</xref><xref ref-type="aff" rid="A2">b</xref></contrib><contrib contrib-type="author"><name><surname>Sadr</surname><given-names>Wafaa El</given-names></name><xref ref-type="aff" rid="A1">a</xref><xref ref-type="aff" rid="A2">b</xref></contrib><on-behalf-of>for the International Center for AIDS Care and Treatment Programs</on-behalf-of></contrib-group><aff id="A1"><label>a</label>International Center for AIDS Care and Treatment Programs (ICAP), Columbia University Mailman School of Public Health, New York, New York USA</aff><aff id="A2"><label>b</label>Department of Epidemiology, Columbia University Mailman School of Public Health, New York, New York USA</aff><aff id="A3"><label>c</label>Epidemiology and Biostatistics Program, CUNY School of Public Health, Hunter College, New York, New York USA</aff><author-notes><corresp id="FN1">Correspondence to Denis Nash, CUNY School of Public Health at Hunter College, 425 E. 25th St, Box 907, New York, NY, USA. Tel: +1 718 530 0684; <email>dnash@hunter.cuny.edu</email></corresp></author-notes><pub-date pub-type="nihms-submitted"><day>9</day><month>7</month><year>2012</year></pub-date><pub-date pub-type="ppub"><day>31</day><month>7</month><year>2011</year></pub-date><pub-date pub-type="pmc-release"><day>20</day><month>8</month><year>2012</year></pub-date><volume>25</volume><issue>12</issue><fpage>1523</fpage><lpage>1533</lpage><permissions><copyright-statement>© 2011 Wolters Kluwer Health | Lippincott Williams & Wilkins</copyright-statement><copyright-year>2011</copyright-year></permissions><abstract><sec id="S1"><title>Objective</title><p id="P1">In sub-Saharan Africa, many patients initiate antiretroviral therapy (ART) at CD4<sup>+</sup> cell counts much lower than those recommended in national guidelines. We examined program-level and contextual-level factors associated with low median CD4<sup>+</sup> cell count at ART initiation in populations initiating ART.</p></sec><sec id="S2"><title>Design</title><p id="P2">Multilevel analysis of aggregate and program-level service delivery data.</p></sec><sec id="S3"><title>Methods</title><p id="P3">We examined data on 1690 cohorts of patients initiating ART during 2004–2008 in eight sub-Saharan African countries. Cohorts with median CD4<sup>+</sup> less than 111 cells/μl (the lowest quartile) were classified as having low median CD4<sup>+</sup> cell count at ART initiation. Cohort information was combined with time-updated program-level data and subnational contextual-level data, and analyzed using multilevel models.</p></sec><sec id="S4"><title>Results</title><p id="P4">The 1690 cohorts had median CD4<sup>+</sup> cell count of 136 cells/μl and included 121 504 patients initiating ART at 267 clinics. Program-level factors associated with low cohort median CD4<sup>+</sup> cell count included urban setting [adjusted odds ratio (AOR) 2.1; 95% confidence interval (CI) 1.3–3.3], lower provider-to-patient ratio (AOR 2.2; 95% CI 1.3–4.0), no PMTCT program (AOR 3.6; 95% CI 1.0–12.8), outreach services for ART patients only vs. both pre-ART and ART patients (AOR 2.4; 95% CI 1.5–3.9), fewer vs. more adherence support services (AOR 1.6; 95% CI 1.0–2.5), and smaller cohort size (AOR 2.5; 95% CI 1.4–4.5). Contextual-level factors associated with low cohort median CD4<sup>+</sup> cell count included initiating ART in areas where a lower proportion of the population heard of AIDS, tested for HIV recently, and a higher proportion believed ‘limiting themselves to one HIV-uninfected sexual partner reduces HIV risk’.</p></sec><sec id="S5"><title>Conclusion</title><p id="P5">Determinants of CD4<sup>+</sup>cell count at ART initiation in populations initiating ART operate at multiple levels. Structural interventions targeting points upstream from ART initiation along the continuum from infection to diagnosis to care engagement are needed.</p></sec></abstract><kwd-group><kwd>CD4</kwd><kwd>HIV/AIDS</kwd><kwd>HIV scale-up</kwd><kwd>implementation science</kwd><kwd>late antiretroviral therapy initiation</kwd><kwd>multilevel</kwd><kwd>operations research</kwd><kwd>PEPFAR</kwd></kwd-group></article-meta></front></pmc></record>Pour manipuler ce document sous Unix (Dilib)
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