Barriers to antiretroviral treatment initiation in rural KwaZulu-Natal, South Africa

Objectives: Although antiretroviral therapy (ART) has been freely available since 2004 in South Africa not all those who are eligible initiate ART. We aimed to investigate individual and household characteristics as barriers to ART initiation in men and women in rural KwaZulu-Natal. Methods: Adults =16 years old living within a sociodemographic surveillance area (DSA) who accessed the local HIV programme between 2007 and 2011 were included in the study. Individual and household factors associated with ART initiation within 3 months of becoming eligible for ART were investigated using multivariable logistic regression stratified by sex and after exclusion of individuals who died before initiating ART. Results: Of the 797 men and 1598 women initially included 8% and 5.5% respectively died before ART initiation and were excluded from further analysis. Of the remaining 733 men and 1510 women 68.2% and 60.2% respectively initiated ART=3 months after becoming eligible (P=0.34 after adjustment for CD4 cell count). In men factors associated with a higher ART initiation rate were being a member of a household located