PMID- 26507824
OWN - NLM
STAT- MEDLINE
DCOM- 20160517
LR  - 20220316
IS  - 1758-2652 (Electronic)
IS  - 1758-2652 (Linking)
VI  - 18
IP  - 1
DP  - 2015
TI  - The clock is ticking: the rate and timeliness of antiretroviral therapy 
      initiation from the time of treatment eligibility in Kenya.
PG  - 20019
LID - 10.7448/IAS.18.1.20019 [doi]
LID - 20019 [doi]
AB  - INTRODUCTION: Understanding the determinants of timely antiretroviral therapy 
      (ART) initiation is useful for HIV programmes intent on developing models of care 
      that reduce delays in treatment initiation while maintaining a high quality of 
      care. We analysed patient- and facility-level determinants of time to ART 
      initiation among patients who initiated ART in Kenya. METHODS: We collected 
      facility-level information and conducted a retrospective chart review of adults 
      initiating ART between 2007 and 2012 at 51 health facilities in Kenya. We 
      evaluated the association between patient- and facility-level covariates at the 
      time of ART eligibility and time to ART initiation. We also explored the 
      determinants associated with timeliness of ART initiation. RESULTS: The analysis 
      included 11,942 patients. The median age at the time eligibility was first 
      determined was 37 years (interquartile range [IQR] 31-45). Overall, 75% of 
      patients initiated ART within two months of eligibility. The median CD4 cell 
      count at the time eligibility was first determined rose from 132 (IQR 51-217) in 
      2007 to 195 (IQR 91-286) in 2011 to 2012 (p<0.001). The cumulative probability of 
      ART initiation among treatment-eligible patients increased over time: 87.1% (95% 
      confidence interval [CI] 85.1-89.0%) in 2007; 96.8% (96.0-97.5%) in 2008; 97.1% 
      (96.3-97.7%) in 2009; 98.5% (98.0 -98.9%) in 2010; and 99.7% (95% CI 99.4 -99.8%) 
      in 2011 to 2012 (p<0.0001). In multivariate analyses, attending a health facility 
      with high ART patient volumes within two months of eligibility was considered the 
      key facility-level determinant of ART initiation (adjusted odds ratio 0.57, 95% 
      CI 0.45-0.72, p<0.001). Patient-level determinants included being eligible for 
      ART in the years subsequent to 2007, advanced World Health Organization clinical 
      stage and low CD4 cell count at the time eligibility was first determined. 
      CONCLUSIONS: Overall, the time between treatment eligibility and ART initiation 
      decreased substantially in Kenya between 2007 and 2012, with uniform gains across 
      different types of health facilities. Our findings highlight the slow increase in 
      CD4 cell counts at the time of ART eligibility over time, indicating that a large 
      number of patients are still beginning ART with advanced HIV disease. Our 
      findings also support the decentralisation of ART services at all health 
      facilities that have the capacity to initiate treatment. Continued evaluation of 
      programme- and country-level data is needed to monitor timeliness of ART 
      initiation as countries continue to expand treatment access.
FAU - Odeny, Thomas A
AU  - Odeny TA
AD  - Institute for Health Metrics and Evaluation, University of Washington Seattle, 
      WA, USA.
AD  - Kenya Medical Research Institute, Nairobi, Kenya; odeny@uw.edu.
FAU - DeCenso, Brendan
AU  - DeCenso B
AD  - RTI International, Research Triangle Park, NC, USA.
FAU - Dansereau, Emily
AU  - Dansereau E
AD  - Institute for Health Metrics and Evaluation, University of Washington Seattle, 
      WA, USA.
FAU - Gasasira, Anne
AU  - Gasasira A
AD  - African Leaders Malaria Alliance, Kampala, Uganda.
FAU - Kisia, Caroline
AU  - Kisia C
AD  - Africa Action Help-International, Nairobi, Kenya.
FAU - Njuguna, Pamela
AU  - Njuguna P
AD  - Afya Resource Associates, Nairobi, Kenya.
FAU - Haakenstad, Annie
AU  - Haakenstad A
AD  - Institute for Health Metrics and Evaluation, University of Washington Seattle, 
      WA, USA.
FAU - Gakidou, Emmanuela
AU  - Gakidou E
AD  - Institute for Health Metrics and Evaluation, University of Washington Seattle, 
      WA, USA.
FAU - Duber, Herbert C
AU  - Duber HC
AD  - Institute for Health Metrics and Evaluation, University of Washington Seattle, 
      WA, USA.
LA  - eng
PT  - Journal Article
DEP - 20151026
PL  - Switzerland
TA  - J Int AIDS Soc
JT  - Journal of the International AIDS Society
JID - 101478566
RN  - 0 (Anti-HIV Agents)
SB  - IM
MH  - Adult
MH  - Aged
MH  - Anti-HIV Agents/*therapeutic use
MH  - CD4 Lymphocyte Count
MH  - Female
MH  - HIV Infections/*drug therapy/immunology
MH  - Humans
MH  - Kenya
MH  - Male
MH  - Middle Aged
MH  - Retrospective Studies
PMC - PMC4623278
OTO - NOTNLM
OT  - ART initiation
OT  - Africa
OT  - HIV
OT  - Kenya
OT  - antiretroviral therapy
OT  - time to start treatment
EDAT- 2015/10/29 06:00
MHDA- 2016/05/18 06:00
PMCR- 2015/10/26
CRDT- 2015/10/29 06:00
PHST- 2015/02/03 00:00 [received]
PHST- 2015/08/23 00:00 [revised]
PHST- 2015/09/08 00:00 [accepted]
PHST- 2015/10/29 06:00 [entrez]
PHST- 2015/10/29 06:00 [pubmed]
PHST- 2016/05/18 06:00 [medline]
PHST- 2015/10/26 00:00 [pmc-release]
AID - 20019 [pii]
AID - 10.7448/IAS.18.1.20019 [doi]
PST - epublish
SO  - J Int AIDS Soc. 2015 Oct 26;18(1):20019. doi: 10.7448/IAS.18.1.20019. eCollection 
      2015.