Factors Associated with Late Initiation of Highly Active Antiretroviral Therapy among Young HIV-Positive Men and Women Aged 18 to 29 Years in Canada

Abstract

Initiating highly active antiretroviral therapy (HAART) with low CD4 counts or AIDS-defining illnesses (ADIs) increases risk of treatment failure and death. We examined factors associated with late initiation among 18-to 29-year-olds within the Canadian Observational Cohort (CANOC) collaboration, a multi-site study of HIV-positive persons who initiated HAART after 2000. Late initiation was defined as beginning HAART with a CD4 count <200 cells/mm 3 and/or having a baseline ADI. Multivariable logistic regression was used to identify independent correlates of late initiation. In total, 1026 individuals (422 from British Columbia, 400 from Ontario, and 204 from Quebec) met our age criteria. At HAART initiation, median age was 27 years (interquartile range, 24, 28 years). A total of 412 individuals (40%) identified as late initiators. Late initiation was associated with female gender, age >25 years at initiation, initiating treatment in earlier years, and having higher baseline viral load. The high number of young adults in our cohort starting HAART late indicates important target populations for specialized services, increased testing, and linkages to care.

Factors associated with delayed and late ART initiation among people living with HIV in BC: results from the engage study

“…Consistent with prior results from BC, older age was associated with late and delayed ART initiation (Lourenco et al, 2015;Palmer et al, 2014). Notably, other research has found younger age to be associated with attrition in HIV care over time (Lourenco et al, 2014), suggesting a missed opportunity to retain younger people.…”

“…Key explanatory variables, established by previous research to impact timing of initiation (Cescon et al, 2015;Joseph et al, 2016;Lourenco et al, 2015;Palmer et al, 2014), included: sex at birth, age, ethnicity, HCV seropositivity, history of IDU, history of homelessness, and income. Additional variables included in this analysis were: physician advice regarding ART initiation, medical reasons for initiating ART, concerns about ART, and participant scores on the Antiretroviral Medication Attitude Scale (AMAS) (Viswanathan, Aanderson, & Thomas, 2005), the HIV Treatment Adherence Self-Efficacy Scale (HIV-ASES) (Johnson et al, 2007), and the Continuity of Care Scale (Uijen et al, 2012).…”

Rates and Correlates of Antiretroviral Therapy Use and Virologic Suppression Among Perinatally and Behaviorally HIV-Infected Youth Linked to Care in the United States

“…It bears mentioning that although the Patient Protection and Affordable Care Act offers great promise for the expansion of health coverage among young adults in particular (i.e., remaining on their parents’ insurance through age 26), there are data suggesting that even in universal access to no-cost care, late initiation of ART occurs among up to 40% of HIV+ men and women aged 18 to 29 years in Canada. 41 Thus, the delays in the initiation of ART or barriers to ART use may be beyond purely economic and also reflect a confluence of cultural, psychosocial, social, and structural etiologies that require further delineation.…”

Influential factors and barriers to opt for the uptake of HIV testing among the adult population at HIV-care admission in an area in the DR Congo: What can we learn?

“…As previously reported in Sub-Saharan Africa countries [34], these factors were incriminated to be responsible for the psychological impact causing a delay the HIV care [35][36][37]. In addition, the inducing role of fear of the knowledge of HIV positive status has been advocated [34] and was considered as a key barrier of utilisation of HIV testing services in Sub-Saharan Africa [38].…”