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. 2011 Nov 13;25(17):2177-81.
doi: 10.1097/QAD.0b013e32834b6464.

Antiretroviral therapy refusal among newly diagnosed HIV-infected adults

Ingrid T Katz  1 , Thandekile Essien, Edmore T Marinda, Glenda E Gray, David R Bangsberg, Neil A Martinson, Guy De Bruyn
Affiliations

Antiretroviral therapy refusal among newly diagnosed HIV-infected adults

Ingrid T Katz et al. AIDS. .

Abstract

Objective: To determine rates and predictors of treatment refusal in newly identified HIV-infected individuals in Soweto, South Africa.

Design: It is designed as a cross-sectional study.

Methods: We analyzed data from adult clients (>18 years) presenting for voluntary counseling and testing (VCT) at the Zazi Testing Center, Perinatal HIV Research Unit to determine rates of antiretroviral therapy (ART) refusal among treatment-eligible, HIV-infected individuals (CD4(+) cell count < 200 cells/μl or WHO stage 4). Multiple logistic regression models were used to investigate factors associated with refusal.

Results: From December 2008 to December 2009, 7287 adult clients were HIV tested after counseling. Two thousand, five hundred and sixty-two (35%) were HIV-infected, of whom 743 (29%) were eligible for immediate ART. One hundred and forty-eight (20%) refused referral to initiate ART, most of whom (92%) continued to refuse after 2 months of counseling. The leading reason for ART refusal was given as 'feeling healthy' (37%), despite clients having a median CD4(+) cell count of 110 cells/μl and triple the rate of active tuberculosis as seen in nonrefusers. In adjusted models, single clients [adjusted odds ratio (AOR) 1.80, 95% confidence interval (CI) 1.06-3.06] and those with active tuberculosis (AOR 3.50, 95% CI 1.55-6.61) were more likely to refuse ART.

Conclusion: Nearly one in five treatment-eligible HIV-infected individuals in Soweto refused to initiate ART after VCT, putting them at higher risk for early mortality. 'Feeling healthy' was given as the most common reason to refuse ART, despite a suppressed CD4(+) count and comorbidities such as tuberculosis. These findings highlight the urgent need for research to inform interventions targeting ART refusers.

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Conflict of interest statement

Conflicts of interest

Disclaimers: There are no conflicts of interest.

Figures

Fig. 1
Fig. 1
Percentage of Testers who Refuse, Treatment, by Reason.
See this image and copyright information in PMC

References

    1. [Accessed March 11, 2011];World Health Organization–Millennium Development Goal 6. http://www.who.int/topics/millennium_development_goals/diseases/en/index....
    1. Lawn SD, Harries AD, Anglaret X, Myer L, Wood R. Early mortality among adults accessing antiretroviral treatment programmes in sub-Saharan Africa. AIDS. 2008;22(15):1897–1908. - PMC - PubMed
    1. May M, Boulle A, Phiri S, Messou E, Myer L, Wood R, Keiser O, Sterne JA, Dabis F, Egger M. IeDEA Southern Africa and West Africa. Prognosis of patients with HIV-1 infection starting antiretroviral therapy in sub-Saharan Africa: a collaborative analysis of scale-up programmes. Lancet. 2010;376(9739):449–457. - PMC - PubMed
    1. World Health Organisation. [Accessed 6 June 2011];Antiretroviral therapy for HIV infection in adults and adolescents: recommendations for a public health approach. 2010 revision. Available at: http://www.who.int/hiv/pub/guidelines/artadultguidelines.pdf. - PubMed
    1. Joint United Nations Program on HIV/AIDS and World Health Organization. 2010 AIDS Epidemic Update.

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