TY - JOUR
T1 - Lack of pre-antiretroviral care and competition from traditional healers, crucial risk factors for very late initiation of antiretroviral therapy for HIV - A case-control study from eastern Uganda
AU - Muhamadi, Lubega
AU - Mbona, Tumwesigye Nazarius
AU - Kadobera, Daniel
AU - Gaetano, Marrone
AU - Wabwire-Mangen, Fred
AU - George, Pariyo
AU - Stefan, Peterson
AU - Mia, Ekström Anna
PY - 2011/1
Y1 - 2011/1
N2 - Background: Although WHO recommends starting antiretroviral treatment at a CD4 count of 350 cells/μL, many Ugandan districts still struggle with large proportions of clients initiating ART very late at CD4 <50 cells/μL. This study seeks to establish crucial risk factors for very late ART initiation in eastern Uganda. Methods: All adult HIV-infected clients on ART in Iganga who enrolled between 2005 and 2009 were eligible for this case-control study. Clients who started ART at CD4 cell count of <50 cells/μL (very late initiators) were classified as cases and 50-200 cells/μL (late initiators) as control subjects. A total of 152 cases and 202 controls were interviewed. Multivariate analyses were performed to calculate adjusted odds ratios and 95% confidence intervals. Results: Reported health system-related factors associated with very late ART initiation were stock-outs of antiretroviral drugs stock-outs (affecting 70% of the cases and none of the controls), competition from traditional/spiritual healers (AOR 7.8, 95 CI% 3.7-16.4), and lack of pre-ARV care (AOR 4.6, 95% CI: 2.3-9.3). Men were 60% more likely and subsistence farmers six times more likely (AOR 6.3, 95% CI: 3.1-13.0) to initiate ART very late. Lack of family support tripled the risk of initiating ART very late (AOR 3.3, 95% CI: 1.6-6.6). Conclusion: Policy makers should prevent ARV stock-outs though effective ARV procurement and supply chain management. New HIV clients should seek pre-ARV care for routine monitoring and determination of ART eligibility. ART services should be more affordable, accessible and userfriendly to make them more attractive than traditional healers.
AB - Background: Although WHO recommends starting antiretroviral treatment at a CD4 count of 350 cells/μL, many Ugandan districts still struggle with large proportions of clients initiating ART very late at CD4 <50 cells/μL. This study seeks to establish crucial risk factors for very late ART initiation in eastern Uganda. Methods: All adult HIV-infected clients on ART in Iganga who enrolled between 2005 and 2009 were eligible for this case-control study. Clients who started ART at CD4 cell count of <50 cells/μL (very late initiators) were classified as cases and 50-200 cells/μL (late initiators) as control subjects. A total of 152 cases and 202 controls were interviewed. Multivariate analyses were performed to calculate adjusted odds ratios and 95% confidence intervals. Results: Reported health system-related factors associated with very late ART initiation were stock-outs of antiretroviral drugs stock-outs (affecting 70% of the cases and none of the controls), competition from traditional/spiritual healers (AOR 7.8, 95 CI% 3.7-16.4), and lack of pre-ARV care (AOR 4.6, 95% CI: 2.3-9.3). Men were 60% more likely and subsistence farmers six times more likely (AOR 6.3, 95% CI: 3.1-13.0) to initiate ART very late. Lack of family support tripled the risk of initiating ART very late (AOR 3.3, 95% CI: 1.6-6.6). Conclusion: Policy makers should prevent ARV stock-outs though effective ARV procurement and supply chain management. New HIV clients should seek pre-ARV care for routine monitoring and determination of ART eligibility. ART services should be more affordable, accessible and userfriendly to make them more attractive than traditional healers.
KW - Competition from traditional healers
KW - Pre-antiretroviral care
KW - Very late ART initiation
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U2 - 10.4314/pamj.v8i1.71155
DO - 10.4314/pamj.v8i1.71155
M3 - Article
C2 - 22121448
AN - SCOPUS:84876463024
SN - 1937-8688
VL - 8
JO - Pan African Medical Journal
JF - Pan African Medical Journal
ER -