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Failure to initiate HIV treatment in patients with high CD4 counts: evidence from demographic surveillance in rural KwaZulu-Natal.

Failure to initiate HIV treatment in patients with high CD4 counts: evidence from demographic surveillance in rural KwaZulu-Natal.
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Bor J, Chiu C, Ahmed S, Katz I, Fox M, Rosen S, Yapa M, Tanser F, Pillay D, Bärnighausen T,


Bor J, Chiu C, Ahmed S, Katz I, Fox M, Rosen S, Yapa M, Tanser F, Pillay D, Bärnighausen T, (click to view)

Bor J, Chiu C, Ahmed S, Katz I, Fox M, Rosen S, Yapa M, Tanser F, Pillay D, Bärnighausen T,

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Tropical medicine & international health : TM & IH 2017 11 21() doi 10.1111/tmi.13013

Abstract
OBJECTIVES
To assess the relationship between CD4 count at presentation and ART uptake and assess predictors of timely treatment initiation in rural KwaZulu-Natal, South Africa.

METHODS
We used Cox Proportional Hazards models to assess the association between first CD4 count and time from first CD4 to ART initiation amongst all treatment-naïve adults presenting to the Hlabisa HIV Treatment and Care Program between August 2011 and December 2012, with CD4<350 cells. For a sub-set of healthier patients (200≤CD4<350 cells) residing within the population surveillance of the Africa Health Research Institute, we assessed sociodemographic, economic, and geographic predictors hypothesized to influence ART uptake. RESULTS
4,739 patients presented for care with eligible CD4 counts. The proportion initiating ART within six months of diagnosis was 67% (95% CI 63, 71) in patients with CD4≤50, 59% (0.55, 0.63) in patients with CD4 151-200, and 48% (95% CI 44, 51) in patients with CD4 301- 350. The hazard of starting ART fell by 17% (95% CI 14, 20) for every 100-cell increase in baseline CD4 count. Among healthier patients under demographic surveillance (n=193), observable sociodemographic, economic, and geographic predictors did not add discriminatory power beyond CD4 count, age, and sex to identify patients at high risk of non-initiation.

CONCLUSIONS
Individuals presenting for HIV care at higher CD4 counts were less likely to initiate ART than patients presenting at low CD4 counts. Overall ART uptake was low. Under new guidelines that establish ART eligibility regardless of CD4 count, patients with high CD4 counts may require additional interventions to encourage treatment initiation. This article is protected by copyright. All rights reserved.

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