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Barriers to Antiretroviral Initiation in HIV-1-Discordant Couples

Identifieur interne : 003E46 ( Main/Curation ); précédent : 003E45; suivant : 003E47

Barriers to Antiretroviral Initiation in HIV-1-Discordant Couples

Auteurs : Brandon L. Guthrie [États-Unis] ; Robert Y. Choi [États-Unis] ; Amy Y. Liu [États-Unis] ; Romel D. Mackelprang [États-Unis] ; Anne F. Rositch ; Rose Bosire [Kenya] ; Lucy Manyara [Kenya] ; Anne Gatuguta [Kenya] ; James N. Kiarie [Kenya] ; Carey Farquhar [États-Unis]

Source :

Journal of acquired immune deficiency syndromes (1999) [ 1525-4135 ] ; 2011.

RBID : PMC:3202340

Descripteurs français

KwdFr :
- Acceptation des soins par le patient (), Adulte, Agents antiVIH (administration et posologie), Caractéristiques familiales, Charge virale, Enquêtes et questionnaires, Facteurs socioéconomiques, Facteurs temps, Femelle, Humains, Infections à VIH (immunologie), Infections à VIH (traitement médicamenteux), Infections à VIH (virologie), Kenya, Mâle, Numération des lymphocytes CD4, Thérapie antirétrovirale hautement active, VIH-1 (Virus de l'Immunodéficience Humaine de type 1) (isolement et purification).
MESH :
- administration et posologie : Agents antiVIH.
- immunologie : Infections à VIH.
- isolement et purification : VIH-1 (Virus de l'Immunodéficience Humaine de type 1).
- traitement médicamenteux : Infections à VIH.
- virologie : Infections à VIH.
- Acceptation des soins par le patient, Adulte, Caractéristiques familiales, Charge virale, Enquêtes et questionnaires, Facteurs socioéconomiques, Facteurs temps, Femelle, Humains, Kenya, Mâle, Numération des lymphocytes CD4, Thérapie antirétrovirale hautement active.
Wicri :
- geographic : Kenya.

English descriptors

KwdEn :
- Adult, Anti-HIV Agents (administration & dosage), Antiretroviral Therapy, Highly Active, CD4 Lymphocyte Count, Family Characteristics, Female, HIV Infections (drug therapy), HIV Infections (immunology), HIV Infections (virology), HIV-1 (isolation & purification), Humans, Kenya, Male, Patient Acceptance of Health Care (statistics & numerical data), Socioeconomic Factors, Surveys and Questionnaires, Time Factors, Viral Load.
MESH :
- chemical , administration & dosage : Anti-HIV Agents.
- geographic : Kenya.
- drug therapy : HIV Infections.
- immunology : HIV Infections.
- isolation & purification : HIV-1.
- statistics & numerical data : Patient Acceptance of Health Care.
- virology : HIV Infections.
- Adult, Antiretroviral Therapy, Highly Active, CD4 Lymphocyte Count, Family Characteristics, Female, Humans, Male, Socioeconomic Factors, Surveys and Questionnaires, Time Factors, Viral Load.

Abstract

BACKGROUND

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.

METHODS

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.

RESULTS

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).

CONCLUSIONS

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.

Url:

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3202340

DOI: 10.1097/QAI.0b013e31822f064e
PubMed: 21826010
PubMed Central: 3202340

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Anne F. Rositch

<affiliation><nlm:aff id="A4">Department of Epidemiology, University of North Carolina</nlm:aff>
<wicri:noCountry code="subfield">University of North Carolina</wicri:noCountry>
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Carey Farquhar

<affiliation><nlm:aff id="A4">Department of Epidemiology, University of North Carolina</nlm:aff>
<wicri:noCountry code="subfield">University of North Carolina</wicri:noCountry>
</affiliation>

<affiliation wicri:level="2"><nlm:aff id="A3">Department of Global Health, University of Washington, Seattle, WA</nlm:aff>
<country xml:lang="fr">États-Unis</country>
<placeName><region type="state">Washington (État)</region>
</placeName>
<wicri:cityArea>Department of Global Health, University of Washington, Seattle</wicri:cityArea>
</affiliation>

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<term>Femelle</term>
<term>Humains</term>
<term>Kenya</term>
<term>Mâle</term>
<term>Numération des lymphocytes CD4</term>
<term>Thérapie antirétrovirale hautement active</term>
</keywords>
<keywords scheme="Wicri" type="geographic" xml:lang="fr"><term>Kenya</term>
</keywords>
</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>
</record>

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	Le SIDA en Afrique subsaharienne (serveur d'exploration)
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Le SIDA en Afrique subsaharienne (serveur d'exploration)

Barriers to Antiretroviral Initiation in HIV-1-Discordant Couples

Barriers to Antiretroviral Initiation in HIV-1-Discordant Couples

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