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

Lubega Muhamadi, Tumwesigye Nazarius Mbona, Daniel Kadobera, Marrone Gaetano, Fred Wabwire-Mangen, Pariyo George, Peterson Stefan, Ekström Anna Mia

Research output: Contribution to journalArticle

Abstract

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.

Original languageEnglish (US)
JournalPan African Medical Journal
Volume8
DOIs
StatePublished - Jan 2011
Externally publishedYes

Keywords

  • Competition from traditional healers
  • Pre-antiretroviral care
  • Very late ART initiation

ASJC Scopus subject areas

  • Medicine(all)

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