PMID- 36647104
OWN - NLM
STAT- MEDLINE
DCOM- 20230118
LR  - 20230201
IS  - 1472-6963 (Electronic)
IS  - 1472-6963 (Linking)
VI  - 23
IP  - 1
DP  - 2023 Jan 16
TI  - Predictors of delayed Anti-Retroviral Therapy initiation among adults referred 
      for HIV treatment in Uganda: a cross-sectional study.
PG  - 40
LID - 10.1186/s12913-023-09052-z [doi]
LID - 40
AB  - BACKGROUND: Uganda's current guidelines recommend immediate initiation of 
      Anti-Retroviral Therapy (ART) for persons living with HIV in order to reduce 
      HIV/AIDS related morbidity and mortality. However, not all eligible PLHIV 
      initiate ART within the recommended time following HIV diagnosis. We assessed the 
      prevalence and factors associated with delayed ART initiation among PLHIV 
      referred for ART initiation, five years since rolling out the test and treat 
      guidelines. METHODS: In this cross-sectional study, we enrolled adult patients 
      referred to Mulago Immune Suppressive Syndrome (Mulago ISS) clinic for ART 
      initiation from January 2017 to May 2021. We collected data on 
      socio-demographics, HIV diagnosis and referral circumstances, and time to ART 
      initiation using a questionnaire. The outcome of interest was proportion of 
      patients that delayed ART, defined as spending more than 30 days from HIV 
      diagnosis to ART initiation. We performed multivariable logistic regression and 
      identified significant factors. RESULTS: A total of 312 patients were enrolled of 
      which 62.2% were female. The median (inter-quartile range [IQR]) age and baseline 
      CD4 count of the patients were 35 (28-42) years and 315 (118.8-580.5) cells/muL 
      respectively. Forty-eight (15.4%) patients delayed ART initiation and had a 
      median (IQR) time to ART of 92 (49.0-273.5) days. The factors associated with 
      delayed ART initiation were; 1) having had the HIV diagnosis made from a private 
      health facility versus public, (adjusted odds ratio [aOR] = 2.4 (95% confidence 
      interval [CI] 1.1-5.5); 2) initial denial of positive HIV test results, aOR = 5.4 
      (95% CI: 2.0-15.0); and, 3) having not received a follow up phone call from the 
      place of HIV diagnosis, aOR = 2.8 (95% CI: 1.2-6.8). CONCLUSION: There was 
      significant delay of ART initiation among referred PLHIV within 5 years after the 
      rollout of test and treat guidelines in Uganda. Health system challenges in the 
      continuity of HIV care services negatively affects timely ART initiation among 
      referred PLHIV in Uganda.
CI  - (c) 2023. The Author(s).
FAU - Kiyingi, Micheal
AU  - Kiyingi M
AD  - Department of Medicine, Makerere University College of Health Sciences, Makerere 
      University, Box 7062, Kampala, Uganda. michealkiyingi@gmail.com.
AD  - Makerere University Joint AIDS Program, Makerere University, Kampala, Uganda. 
      michealkiyingi@gmail.com.
FAU - Nankabirwa, Joaniter I
AU  - Nankabirwa JI
AD  - Department of Medicine, Makerere University College of Health Sciences, Makerere 
      University, Box 7062, Kampala, Uganda.
AD  - Infectious Diseases Research Collaboration, Kampala, Uganda.
FAU - Sekaggya-Wiltshire, Christine
AU  - Sekaggya-Wiltshire C
AD  - Infectious Diseases Institute, Makerere University, Kampala, Uganda.
FAU - Nangendo, Joan
AU  - Nangendo J
AD  - Department of Medicine, Makerere University College of Health Sciences, Makerere 
      University, Box 7062, Kampala, Uganda.
AD  - Infectious Diseases Research Collaboration, Kampala, Uganda.
FAU - Kiweewa, John M
AU  - Kiweewa JM
AD  - Education Department, Fairfield University, Fairfield, CT, USA.
FAU - Katahoire, Anne R
AU  - Katahoire AR
AD  - Child Health and Development Center, Makerere University, Kampala, Uganda.
FAU - Semitala, Fred C
AU  - Semitala FC
AD  - Department of Medicine, Makerere University College of Health Sciences, Makerere 
      University, Box 7062, Kampala, Uganda.
AD  - Makerere University Joint AIDS Program, Makerere University, Kampala, Uganda.
AD  - Infectious Diseases Research Collaboration, Kampala, Uganda.
LA  - eng
GR  - D43 TW011304/TW/FIC NIH HHS/United States
PT  - Journal Article
DEP - 20230116
PL  - England
TA  - BMC Health Serv Res
JT  - BMC health services research
JID - 101088677
RN  - 0 (Anti-HIV Agents)
SB  - IM
MH  - Humans
MH  - Adult
MH  - Female
MH  - Male
MH  - Cross-Sectional Studies
MH  - Uganda/epidemiology
MH  - *HIV Infections/diagnosis/drug therapy/epidemiology
MH  - Antiretroviral Therapy, Highly Active
MH  - *Acquired Immunodeficiency Syndrome/drug therapy
MH  - CD4 Lymphocyte Count
MH  - *Anti-HIV Agents/therapeutic use
PMC - PMC9843953
OTO - NOTNLM
OT  - Anti-retroviral therapy
OT  - Initiation
OT  - Persons living with HIV
OT  - Predictors
OT  - Prevalence
OT  - Referral
COIS- The authors declare no conflict of interests.
EDAT- 2023/01/17 06:00
MHDA- 2023/01/19 06:00
PMCR- 2023/01/16
CRDT- 2023/01/16 23:38
PHST- 2022/08/19 00:00 [received]
PHST- 2023/01/09 00:00 [accepted]
PHST- 2023/01/16 23:38 [entrez]
PHST- 2023/01/17 06:00 [pubmed]
PHST- 2023/01/19 06:00 [medline]
PHST- 2023/01/16 00:00 [pmc-release]
AID - 10.1186/s12913-023-09052-z [pii]
AID - 9052 [pii]
AID - 10.1186/s12913-023-09052-z [doi]
PST - epublish
SO  - BMC Health Serv Res. 2023 Jan 16;23(1):40. doi: 10.1186/s12913-023-09052-z.