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Time to Initiation of Antiretroviral Therapy Among Patients Who Are ART Eligible in Rwanda
- Source :
- JAIDS Journal of Acquired Immune Deficiency Syndromes. 68:314-321
- Publication Year :
- 2015
- Publisher :
- Ovid Technologies (Wolters Kluwer Health), 2015.
-
Abstract
- BACKGROUND: Delayed initiation of antiretroviral therapy (ART) in eligible patients is a concern in resource-limited countries. METHODS: We analyzed data on HIV-positive patients >/=15 years enrolled at 41 ICAP-supported health care facilities in Rwanda 2005-2010 to determine time to ART initiation among patients eligible at enrollment compared with those ineligible or of indeterminate eligibility who become eligible during follow-up. ART eligibility was based on CD4 cell count (CD4) and WHO staging; patients lacking CD4 and WHO stage were considered indeterminate. Cumulative incidence of reaching ART eligibility and to ART initiation after eligibility was generated using competing risk estimators. RESULTS: A total of 31033 ART-naive adults were enrolled; 64.2% were female. At enrollment 10158 (32.7%) patients were ART eligible 13372 (43.1%) were ineligible for ART and 7503 (24.2%) patients were indeterminate. Among patients retained in care pre-ART eligibility 17.9% [95% confidence interval (CI): 17.2 to 18.6] of ineligible and 22.8% (95% CI: 21.7 to 23.8) of indeterminate patients at enrollment reached ART eligibility within 12 months. Cumulative incidence of ART initiation within 3 months for patients eligible at enrollment was 77.2% (95% CI: 76.4 to 78.0) compared with 67.9% (95% CI: 66.4 to 69.3) for ineligible and 63.8% (95% CI: 61.9 to 65.8) for patients with indeterminate eligibility at enrollment (P < 0.05). Over the study period there was more rapid ART initiation for patients who became ART eligible. CONCLUSIONS: We found higher rates of ART initiation within 3 months among patients who were ART eligible at enrollment compared with those who reached eligibility during follow-up. From 2006 to 2011 earlier initiation of ART after eligibility was observed likely reflecting improved program quality.
- Subjects :
- Adult
Male
Pediatrics
medicine.medical_specialty
Time Factors
Adolescent
Art initiation
HIV Infections
Severity of Illness Index
Article
Young Adult
Antiretroviral Therapy, Highly Active
Severity of illness
medicine
Humans
Pharmacology (medical)
Cumulative incidence
Longitudinal Studies
Young adult
Cd4 cell count
Stage (cooking)
Aged
business.industry
Rwanda
Middle Aged
Antiretroviral therapy
Confidence interval
CD4 Lymphocyte Count
Infectious Diseases
Anti-Retroviral Agents
Female
business
Subjects
Details
- ISSN :
- 15254135
- Volume :
- 68
- Database :
- OpenAIRE
- Journal :
- JAIDS Journal of Acquired Immune Deficiency Syndromes
- Accession number :
- edsair.doi.dedup.....d15ae06dbb467350481eed875e6d64ec