Predictors of antiretroviral therapy initiation in eThekwini (Durban), South Africa: Findings from a prospective cohort study

• Published in: PloS one 2021-02, Vol.16 (2), p.e0246744-e0246744
• Main Authors: Sy, Karla Therese L, Tariq, Shema, Ramjee, Gita, Blanchard, Kelly, Leu, Cheng-Shiun, Kelvin, Elizabeth A, Exner, Theresa M, Gandhi, Anisha D, Lince-Deroche, Naomi, Mantell, Joanne E, O'Sullivan, Lucia F, Hoffman, Susie
• Format: Article
• Language: English
• Subjects: Adult; Anti-HIV Agents - therapeutic use; Anti-Retroviral Agents - therapeutic use; Antiretroviral agents; Antiretroviral drugs; Antiretroviral therapy; Biology and Life Sciences; CD4 antigen; CD4 Lymphocyte Count; Clinics; Cohort analysis; Cohort Studies; Demography; Drug therapy; Editing; Epidemiology; Female; Funding; Gender; Graduate schools; Graduate studies; Health policy; Highly active antiretroviral therapy; HIV; HIV Infections - diagnosis; HIV Infections - drug therapy; HIV Infections - psychology; HIV patients; Human immunodeficiency virus; Humans; Kaplan-Meier Estimate; Male; Medical diagnosis; Medical records; Medicine and Health Sciences; Methodology; Morbidity; Patient compliance; People and places; Pregnancy; Proportional Hazards Models; Prospective Studies; Psychological aspects; Psychology; Public health; Public sector; Reproductive health; Rural areas; Sexuality; Sexually transmitted diseases; Social Sciences; Sociodemographics; Socioeconomic Factors; South Africa; Statistics; STD; Traditional medicine; Tuberculosis
• ISSN: 1932-6203; 1932-6203
• DOI: 10.1371/journal.pone.0246744

Despite expanded antiretroviral therapy (ART) eligibility in South Africa, many people diagnosed with HIV do not initiate ART promptly, yet understanding of the reasons is limited. Using data from an 8-month prospective cohort interview study of women and men newly-diagnosed with HIV in three public-sector primary care clinics in the eThekwini (Durban) region, South Africa, 2010-2014, we examined if theoretically-relevant social-structural, social-cognitive, psychosocial, and health status indicators were associated with time to ART initiation. Of 459 diagnosed, 350 returned to the clinic for their CD4+ test results (linkage); 153 (33.3%) were ART-eligible according to treatment criteria at the time; 115 (75.2% of those eligible) initiated ART (median = 12.86 weeks [95% CI: 9.75, 15.97] after linkage). In adjusted Cox proportional hazard models, internalized stigma was associated with a 65% decrease in the rate of ART initiation (Adjusted hazard ratio [AHR] 0.35, 95% CI: 0.19-0.80) during the period less than four weeks after linkage to care, but not four or more weeks after linkage to care, suggesting that stigma-reduction interventions implemented shortly after diagnosis may accelerate ART uptake. As reported by others, older age was associated with more rapid ART initiation (AHR for 1-year age increase: 1.04, 95% CI: 1.01-1.07) and higher CD4+ cell count (≥300μL vs.