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Evidence of improving antiretroviral therapy treatment delays : an analysis of eight years of programmatic outcomes in Blantyre, Malawi

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Evidence_of_improving_ART_treatment_delays.pdf (417.0Kb)
Date
21/05/2013
Author
Sloan, Derek J.
Van Oosterhout, Joep J.
Malisita, Ken
Phiri, Eddie M.
Lalloo, David G.
O'Hare, Bernadette
MacPherson, Peter
Keywords
Africa
Antiretroviral therapy
HIV
HIV testing and counselling
Linkage to care
Programmatic research
QR355 Virology
RA Public aspects of medicine
Public Health, Environmental and Occupational Health
SDG 3 - Good Health and Well-being
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Abstract
AbstractBackground: Impressive achievements have been made towards achieving universal coverage of antiretroviral therapy (ART) in sub-Saharan Africa. However, the effects of rapid ART scale-up on delays between HIV diagnosisand treatment initiation have not been well described.Methods: A retrospective cohort study covering eight years of ART initiators (2004–2011) was conducted at Queen Elizabeth Central Hospital (QECH) in Blantyre, Malawi. The time between most recent positive HIV test and ARTinitiation was calculated and temporal trends in delay to initiation were described. Factors associated with time to initiation were investigated using multivariate regression analysis.Results: From 2004–2011, there were 15,949 ART initiations at QECH (56% female; 8% children [0–10 years] and 5% adolescents [10–20 years]). Male initiators were likely to have more advanced HIV infection at initiation than female initiators (70% vs. 64% in WHO stage 3 or 4). Over the eight years studied, there were declines in treatment delay, with 2011 having the shortest delay at 36.5 days. On multivariate analysis CD4 count <50 cells/μl (adjusted geometric mean ratio [aGMR]: aGMR: 0.53, bias-corrected accelerated [BCA] 95% CI: 0.42-0.68) was associated with shorter ART treatment delay. Women (aGMR: 1.12, BCA 95% CI: 1.03-1.22) and patients diagnosed with HIV at another facility outside QECH (aGMR: 1.61, BCA 95% CI: 1.47-1.77) had significantly longer treatment delay.Conclusions: Continued improvements in treatment delays provide evidence that universal access to ART can be achieved using the public health approach adopted by Malawi However, the longer delays for women and patients diagnosed at outlying sites emphasises the need for targeted interventions to support equitable access for these groups.
Citation
Sloan , D J , Van Oosterhout , J J , Malisita , K , Phiri , E M , Lalloo , D G , O'Hare , B & MacPherson , P 2013 , ' Evidence of improving antiretroviral therapy treatment delays : an analysis of eight years of programmatic outcomes in Blantyre, Malawi ' , BMC Public Health , vol. 13 , 490 . https://doi.org/10.1186/1471-2458-13-490
Publication
BMC Public Health
Status
Peer reviewed
DOI
https://doi.org/10.1186/1471-2458-13-490
ISSN
1471-2458
Type
Journal article
Rights
© 2013 Sloan et al.; licensee BioMed Central Ltd. This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/2.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.
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URL
http://www.biomedcentral.com/1471-2458/13/490
URI
http://hdl.handle.net/10023/3562

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