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. 2014 Feb 1;65(2):e41-9.
doi: 10.1097/QAI.0b013e31829ceaec.

Risk factors for delayed initiation of combination antiretroviral therapy in rural north central Nigeria

Muktar H Aliyu  1 , Meridith Blevins, Deidra D Parrish, Karen M Megazzini, Usman I Gebi, Mukhtar Y Muhammad, Mukhtar L Ahmed, Adiba Hassan, Bryan E Shepherd, Sten H Vermund, C William Wester
Affiliations

Risk factors for delayed initiation of combination antiretroviral therapy in rural north central Nigeria

Muktar H Aliyu et al. J Acquir Immune Defic Syndr. .

Abstract

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.

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Figures

Figure 1
Figure 1
Flowchart depicting enrollment and ART eligibility for adult patients with HIV/AIDS, Kwara and Niger states of Nigeria, 2009–2011.
Figure 2
Figure 2
Combination antiretroviral therapy initiation during the first 90 days post-enrollment, Kwara and Niger states of Nigeria, 2009–2011.
See this image and copyright information in PMC

References

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