Barriers to antiretroviral initiation in HIV-1-discordant couples

Brandon L. Guthrie, Robert Y. Choi, Amy Y. Liu, Romel D. MacKelprang, Anne F. Rositch, Rose Bosire, Lucy Manyara, Ann Gatuguta, James N. Kiarie, Carey Farquhar

Research output: Contribution to journalArticlepeer-review

22 Scopus citations


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 US President's Emergency Plan for AIDS Relief-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 (hazard ratio = 0.49, P < 0.001). Compared with 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 one-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.

Original languageEnglish (US)
Pages (from-to)e87-e93
JournalJournal of Acquired Immune Deficiency Syndromes
Issue number3
StatePublished - Nov 1 2011
Externally publishedYes


  • ART
  • HIV
  • antiretroviral
  • discordant couples
  • serodiscordant

ASJC Scopus subject areas

  • Infectious Diseases
  • Pharmacology (medical)


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