Margaret Nassim Jahangir
Kilifi County Hospital, Kenya
Title: Burden and risk factors for late antiretroviral therapy initiation in a rural hiv clinic in Kilifi, Kenya
Biography
Biography: Margaret Nassim Jahangir
Abstract
Background: Despite scale up of antiretroviral therapy (ART) in sub-Saharan Africa, patients continue to initiate ART at an advanced stage of HIV infection, leading to poor outcomes.
Method: A retrospective analysis of routinely collected data from the HIV clinic at Kilifi County Hospital was done. Adults (≥15 years) initiated ART during 2008-2013 were included. The primary outcome was late ART initiation, defined as a baseline CD4 T-cell count of ≤100 cells/µL at ART initiation. Logistic regression was used to describe risk factors of late ART initiation.
Results: Overall, 1112 (female, n=790 [71.0%]; mean age, 37.5 [SD, 10.3] years) individuals were initiated ART during 2008-2013. The mean CD4 count at initiation was 211 [SD, 212]. Nearly a third (n=346 [31.1%]) initiated ART late. In multivariate analyses, male gender (Adjusted Odds Ratio, [95% C.I.], p-value: 1.5 [1.1-2.1] p=0.014), WHO Staging (stage IV vs. stage I; 4.6 [2.3-8.9], p<0.001), severe malnutrition (BMI<16 vs. BMI>18.5; 4.9 [3.0-7.8], p<0.001) and pre-ART duration (<6 months vs. >12 months: 2.7 [1.8-4.1] p<0.001) were associated with late ART initiation.
Conclusion: Findings show that about 1/3 of patients are initiating ART late. Patients who initiated ART<6 months after enrolment were more likely to have advanced HIV infection, suggesting that the clinic is succeeding in initiating ART rapidly but failing to catch patients early for enrolment into care. Men are particularly at risk and more needs to be done. Findings also emphasize use of malnutrition and advanced clinical staging as indicators to target sick patients for ART initiation, rather than waiting for CD4 testing.