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

• Published in: The Pan African medical journal 2011-04, Vol.8 (40)
• Main Authors: Muhamadi, Lubega, Tumwesigye, Nazarius Mbona, Kadobera, Daniel, Marrone, Gaetano, Wabwire-Mangen, Fred, Pariyo, George, Peterson, Stefan, Ekström, Anna Mia
• Format: Article
• Language: English
• Subjects: competition from traditional healers; pre-antiretroviral care; very late art initiation
• ISSN: 1937-8688; 1937-8688
• DOI: 10.11604/pamj.2011.8.40.539

BACKGROUND: Although WHO recommends starting antiretroviral treatment at a CD4 count of 350 cells/[µ]L, many Ugandan districts still struggle with large proportions of clients initiating ART very late at CD4 < 50 cells/[µ]L. 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/[µ]L (very late initiators) were classified as cases and 50-200 cells/[µ]L (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 user-friendly to make them more attractive than traditional healers.