Failure to initiate HIV treatment in patients with high CD4 counts: evidence from demographic surveillance in rural South Africa
| Autor: | Jacob Bor, Till Bärnighausen, Matthew P. Fox, Shahira Ahmed, Frank Tanser, Deenan Pillay, Ingrid T. Katz, Sydney Rosen, Manisha Yapa, Calvin Chiu |
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| Rok vydání: | 2017 |
| Předmět: |
0301 basic medicine
Adult Male Rural Population medicine.medical_specialty Art initiation Population Psychological intervention Human immunodeficiency virus (HIV) HIV Infections medicine.disease_cause Article Discriminatory power 03 medical and health sciences South Africa 0302 clinical medicine Medicine Humans In patient 030212 general & internal medicine Hiv treatment education Intensive care medicine Proportional Hazards Models education.field_of_study business.industry Proportional hazards model Public Health Environmental and Occupational Health Patient Acceptance of Health Care 030112 virology 3. Good health CD4 Lymphocyte Count Infectious Diseases Disease Progression Patient Compliance Parasitology Female business Attitude to Health Demography |
| Zdroj: | Tropical medicineinternational health : TMIH. 23(2) |
| ISSN: | 1365-3156 |
| Popis: | Objectives To assess the relationship between CD4 count at presentation and ART uptake and assess predictors of timely treatment initiation in rural KwaZulu‐Natal, South Africa. Methods We used Kaplan‐Meier and Cox proportional hazards models to assess the association between first CD4 count and time from first CD4 to ART initiation among all adults presenting to the Hlabisa HIV Treatment and Care Programme between August 2011 and December 2012 with treatment‐eligible CD4 counts (≤ 350 cells/mm3). For a subset of healthier patients (200 < CD4 ≤ 350 cells) residing within the population surveillance of the Africa Health Research Institute, we assessed sociodemographic, economic and geographic predictors hypothesised to influence ART uptake. Results A total of 4739 patients presented for care with eligible CD4 counts. The proportion initiating ART within six months of diagnosis was 67% (95% CI 63, 71) in patients with CD4 ≤ 50, 59% (0.55, 0.63) in patients with CD4 151–200 and 48% (95% CI 44, 51) in patients with CD4 301–350. The hazard of starting ART fell by 17% (95% CI 14, 20) for every 100‐cell increase in baseline CD4 count. Among healthier patients under demographic surveillance (n = 193), observable sociodemographic, economic and geographic predictors did not add discriminatory power beyond CD4 count, age and sex to identify patients at high risk of non‐initiation. Conclusions Individuals presenting for HIV care at higher CD4 counts were less likely to initiate ART than patients presenting at low CD4 counts. Overall, ART uptake was low. Under new guidelines that establish ART eligibility regardless of CD4 count, patients with high CD4 counts may require additional interventions to encourage treatment initiation. |
| Databáze: | OpenAIRE |
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