Continuum in HIV care from entry to ART initiation in rural KwaZulu-Natal, South Africa.

Autor: Plazy M; Centre de recherche Inserm U897 Epidémiologie et Biostatistique, Université Bordeaux, Bordeaux, France.; Institut de Santé Publique, d'Epidémiologie et de Développement (ISPED), Université Bordeaux, Bordeaux, France., Dray-Spira R; Epidemiology of Occupational and Social Determinants of Health-Center for Research in Epidemiology and Population Health, Villejuif, France.; Université Versailles Saint-Quentin en Yvelines, Villejuif, France., Orne-Gliemann J; Centre de recherche Inserm U897 Epidémiologie et Biostatistique, Université Bordeaux, Bordeaux, France.; Institut de Santé Publique, d'Epidémiologie et de Développement (ISPED), Université Bordeaux, Bordeaux, France., Dabis F; Centre de recherche Inserm U897 Epidémiologie et Biostatistique, Université Bordeaux, Bordeaux, France.; Institut de Santé Publique, d'Epidémiologie et de Développement (ISPED), Université Bordeaux, Bordeaux, France., Newell ML; Africa Centre for Health and Population Studies, University of KwaZulu-Natal, Somkhele, South Africa.; Faculty of Medicine, University of Southampton, Southampton, UK.
Jazyk: angličtina
Zdroj: Tropical medicine & international health : TM & IH [Trop Med Int Health] 2014 Jun; Vol. 19 (6), pp. 680-689. Date of Electronic Publication: 2014 Mar 21.
DOI: 10.1111/tmi.12301
Abstrakt: Objective: To quantify time from entry in HIV care until Antiretroviral therapy (ART) initiation and identify factors associated with ART initiation in rural KwaZulu-Natal, South Africa.
Methods: Adults ≥16 years entering the decentralised Hlabisa ART programme between 2007 and 2011 were followed until June 2013. Median survival times to ART initiation from date of programme entry and from date of ART eligibility were estimated with Kaplan-Meier methods. Associated factors were evaluated in Cox regressions, censoring for deaths.
Results: Of 37 749 adults (71.6% female), 17 638 (46.7%) initiated ART. Nearly half (46.9%) met the CD4 criteria for treatment eligibility at programme entry. Among the 20 039 individuals not yet ART-eligible at entry, only 62.5% were retained in care with at least one further CD4 measurement, of whom 6688 subsequently became ART-eligible. Overall, 65.5% of the 24 398 ART-eligible individuals initiated ART over the study period. ART initiation was more likely in women (P < 0.001), in individuals ≥ 25 years old (P < 0.001) and in patients with low CD4 count (P < 0.001). Patients who became eligible during follow up were significantly more likely to initiate ART than those eligible at programme entry (72.6% vs. 62.9%, Adjusted Hazard Ratio = 1.46; 95% Confidence Interval [1.41-1.51]), adjusting for sex, age, year and CD4 count at eligibility.
Conclusions: In this rural programme, continuation of care remains challenging, especially in men and younger adults. ART initiation is more likely in those engaged prior eligibility than in those entering HIV care only late in their HIV disease.
(© 2014 John Wiley & Sons Ltd.)
Databáze: MEDLINE
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