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Risk Factors for Delayed Initiation of Combination Antiretroviral Therapy in Rural North Central Nigeria

Aliyu, H., Muktar ; Blevins, D., Meridith ; Parrish, M., Deidra ; Megazzini, I., Karen ; Gebi, Y., Usman ; Muhammad, L., Mukhtar ; Ahmed, E., Mukhtar ; Hassan, H., Adiba ; Shepherd, William, Bryan ; Vermund, William, Sten ; Wester, William, C.

JAIDS Journal of Acquired Immune Deficiency Syndromes, 2014, Vol.65(2), pp.e41-e49 [Peer Reviewed Journal]

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  • Title:
    Risk Factors for Delayed Initiation of Combination Antiretroviral Therapy in Rural North Central Nigeria
  • Author/Creator: Aliyu, H., Muktar ; Blevins, D., Meridith ; Parrish, M., Deidra ; Megazzini, I., Karen ; Gebi, Y., Usman ; Muhammad, L., Mukhtar ; Ahmed, E., Mukhtar ; Hassan, H., Adiba ; Shepherd, William, Bryan ; Vermund, William, Sten ; Wester, William, C.
  • Subjects: Acquired Immune Deficiency Syndrome ; Niger ; Medical and Environmental Health ; Diseases/Injuries/Trauma
  • Is Part Of: JAIDS Journal of Acquired Immune Deficiency Syndromes, 2014, Vol.65(2), pp.e41-e49
  • Description: BACKGROUND:: Timely initiation of combination antiretroviral therapy (ART) in eligible HIV-infected patients is associated with substantial reduction in mortality and morbidity. Nigeria has the second largest number of persons living with HIV/AIDS in the world. We examined patient characteristics, time to ART initiation, retention, and mortality at 5 rural facilities in Kwara and Niger states of Nigeria. METHODS:: We analyzed program-level cohort data for HIV-infected ART-naive clients (≥15 years) enrolled from June 2009 to February 2011. We modeled the probability of ART initiation among clients meeting national ART eligibility criteria using logistic regression with splines. RESULTS:: We enrolled 1948 ART-naive adults/adolescents into care, of whom, 1174 were ART eligible (62% female). Only 74% of the eligible patients (n = 869) initiated ART within 90 days after enrollment. The median CD4 count for eligible clients was 156 cells/μL (interquartile range: 81–257), with 67% in WHO stage III/IV disease. Adjusting for CD4 count, WHO stage, functional status, hemoglobin, body mass index, sex, age, education, marital status, employment, clinic of attendance, and month of enrollment, we found that immunosuppression [CD4 350 vs. 200, odds ratio (OR) = 2.10, 95% confidence interval (CI): 1.31 to 3.35], functional status [bedridden vs. working, OR = 4.17 (95% CI: 1.63 to 10.67)], clinic of attendance [Kuta Hospital vs. referent: OR = 5.70 (95% CI: 2.99 to 10.89)], and date of enrollment [December 2010 vs. June 2009: OR = 2.13 (95% CI: 1.19 to 3.81)] were associated with delayed ART initiation. CONCLUSIONS:: Delayed initiation of ART was associated with higher CD4 counts, lower functional status, clinic of attendance, and later dates of enrollment among ART-eligible clients. Our findings provide targets for quality improvement efforts that may help reduce attrition and improve ART uptake in similar settings.
  • Identifier: ISSN: 1525-4135 ; DOI: 10.1097/QAI.0b013e31829ceaec