Delayed ART initiation in “Test and Treat era” and its associated factors among adults receiving antiretroviral therapy at public health institutions in Northwest Ethiopia: A multicenter cross-sectional study

Abstract

Background Antiretroviral therapy (ART) has shown promising effects on the reduction of new HIV infection as well as HIV-related morbidity and mortality. In order to boost the effect of ART on ending HIV epidemics by 2030, the World Health Organization (WHO) indeed introduced a universal test and treat strategy in 2015 that recommends rapid (within seven days) initiation of ART for all HIV-positive patients. However, in low-income countries, a substantial number of HIV-positive patients were not enrolled in time, and information on delayed ART initiation status in Ethiopia is limited. Method A multicenter cross-sectional study was conducted on 400 HIV-positive adults receiving ART at public health institutions in Bahir Dar city, Northwest Ethiopia. A structured checklist was used to extract data from the patient’s medical record. Data was entered into Epi-data version 4.6 and exported to SPSS version 26 for further analysis. Both simple and multivariable binary logistic regressions were executed, and variables with a p-value < 0.05 in the final model were considered significant predictors of delayed ART initiation. Results The magnitude of delayed ART initiation was 39% (95% CI: 34%–44%). Being male [Adjusted odds ratio(AOR) = 1.99, 95%CI:1.3–3.2], having opportunistic infections (OIs) [AOR = 2.50, 95%CI:1.4–4.6], having other chronic diseases [AOR = 3.70,95%CI:1.7–8.3], substance abuse [AOR = 3.79, 95%CI: 1.9–7.4], having ambulatory functional status [AOR = 5.38, 95%CI: 1.4–9.6] and didn’t have other HIV-positive family member [AOR = 1.85, 95%CI: 1.2–2.9] increases the odds of delayed ART initiation. Conclusion and recommendation The burden of delayed ART initiation is found to be high. The presence of OIs and other chronic problems, substance abuse, ambulatory functional status, being male, and not having other HIV-positive family members were identified as significant predictors of delayed ART initiation. Special emphasis needs to be considered for those individuals with the identified risk factors.

Predictors of delayed Anti-Retroviral Therapy initiation among adults referred for HIV treatment in Uganda: a cross-sectional study

“…Larger studies investigating linkage to care from different testing settings are needed to study this phenomenon further. On the other hand, we did not find statistical significance with other individual factors like sex, age and socio-economic status which have been found to affect ART initiation in most other studies previously conducted in SSA [ 12 , 13 , 37 ]. This may be because we studied a population with very limited information in our setting.…”

“…Most studies on delayed ART initiation in Uganda have been conducted among hospitalized patients [10,11] reporting over 50% of patients delaying ART, with a CD4 > 50 cells/μL and long distance from health facility associated with delayed ART initiation. Other factors associated with delayed ART initiation found elsewhere were male gender, low education level, older age, opportunistic infections and a high CD4 count [8,[12][13][14][15]. Previous studies in SSA show that patients tend to initiate ART at low CD4 counts despite test and treat, and the prevalence of advanced HIV disease is still high [16][17][18][19][20].…”

Incidence and predictors of virological failure among children receiving first-line anti-retroviral treatment in public comprehensive specialized hospitals found in Northeast Ethiopia: a retrospective follow-up study

“…This study indicates a delay in children's ART initiation age. High rates of late ART initiation in pediatric (53.2%) ( 54 ) and adult (39%) ( 55 ) populations nationwide provided proof for this claim. The study's greater proportion of rural inhabitants, the absence of HIV-positive family members ( 54 , 55 ), the low financial status of families or caregivers, and the lack of awareness about the advantages of initiating HIV treatment early ( 56 ) could be the causes.…”

Factors associated with late initiation of antiretroviral therapy in Iran’s HIV/AIDS surveillance data

“…While there is an extreme fear of stigma and discrimination among MSM individuals in Iran, to mitigate the fear of the negative social consequences of HIV infection, establishment of anonymous voluntary counseling and testing (aVCT) for HIV might have a role in the observed decrease in our study 41 . This result might also reflect the greater perceived risk of and awareness about HIV/AIDS among MSM, leading to early diagnostic, preventive, and treatment services 26 , 59 .…”