BioSpace.com

Biotech and Pharmaceutical
News & Jobs
Search the Site
 
   
Biotechnology and Pharmaceutical Channel Medical Device and Diagnostics Channel Clinical Research Channel BioSpace Collaborative    Job Seekers:  Register | Login          Employers:  Register | Login  

NEWSLETTERS
Free Newsletters
Archive
My Subscriptions

NEWS
News by Subject
News by Disease
News by Date
PLoS
Search News
Post Your News
JoVE

CAREER NETWORK
Job Seeker Login
Most Recent Jobs
Browse Biotech Jobs
Search Jobs
Post Resume
Career Fairs
Career Resources
For Employers

HOTBEDS
Regional News
US & Canada
  Biotech Bay
  Biotech Beach
  Genetown
  Pharm Country
  BioCapital
  BioMidwest
  Bio NC
  BioForest
  Southern Pharm
  BioCanada East
  US Device
Europe
Asia

DIVERSITY

INVESTOR
Market Summary
News
IPOs

PROFILES
Company Profiles

START UPS
Companies
Events

INTELLIGENCE
Research Store

INDUSTRY EVENTS
Biotech Events
Post an Event
RESOURCES
Real Estate
Business Opportunities

PLoS By Category | Recent PLoS Articles
Infectious Diseases - Non-Clinical Medicine - Public Health and Epidemiology - Women's Health

Factors Associated with Late Antiretroviral Therapy Initiation among Adults in Mozambique
Published: Tuesday, May 15, 2012
Author: Maria Lahuerta et al.

by Maria Lahuerta, Josue Lima, Harriet Nuwagaba-Biribonwoha, Mie Okamura, Maria Fernanda Alvim, Rufino Fernandes, Americo Assan, David Hoos, Batya Elul, Wafaa M. El-Sadr, Denis Nash

Background

Despite recent changes to expand the ART eligibility criteria in sub-Saharan Africa, many patients still initiate ART in the advanced stages of HIV infection, which contributes to increased early mortality rates, poor patient outcomes, and onward transmission.

Methods

To evaluate individual and clinic-level factors associated with late ART initiation in Mozambique, we conducted a retrospective sex-specific analysis of data from 36,411 adult patients who started ART between January 2005 and June 2009 at 25 HIV clinics in Mozambique. Late ART initiation was defined as CD4 count<100 cells/µL or WHO stage IV. Mixed effects models were used to identify patient- and clinic-level factors associated with late ART initiation.

Results

The proportion of patients initiating ART late decreased from 46% to 37% during 2005–2007, but remained constant (between 37–33%) from 2007–2009. Of those who initiated ART late (median CD4?=?57 cells/µL), 5% were known to have died and 54% were lost to clinic within 6 months of ART initiation (compared with 2% and 47% among other patients starting ART [median CD4?=?192 cells/µL]). In multivariate analysis, female sex and pregnancy at ART initiation (AORfemale_not_pregnant_vs._male?=?0.66, 95%CI [0.62–0.69]; AORpregnant_vs._non_pregnant?=?0.60, 95%CI [0.49–0.73]), younger and older age (AOR15–25_vs.26–30?=?0.86, 95%CI [0.79–0.94], AOR>45_vs.26–30?=?0.72, 95%CI [0.67–0.77]), entry into care via PMTCT (AORentry_through_PMTCT_vs.VCT?=?0.42, 95%CI [0.35–0.50]), marital status (AORmarried/in union_vs.single?=?0.87, 95%CI [0.83–0.92]), education (AORsecondary_or_higher_vs.primary?=?0.87, 95%CI [0.83–0.93]) and year of ART initiation were associated with a lower likelihood of late ART initiation. Clinic-level factors independently associated with a lower likelihood of late ART initiation included CD4 machine on-site (AORCD4_machine_onsite_vs.offsite?=?0.83, 95%CI [0.74–0.94]) and presence of PMTCT services onsite (AOR?=?0.85, 95%CI [0.77–0.93]).

Conclusion:

The risk of starting ART late remained persistently high. Efforts are needed to ensure identification and enrollment of patients at earlier stages of HIV disease. Individual and clinic level factors identified may provide clues for upstream structural interventions.

  More...

 

//-->