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. 2020 Jan-Dec:19:2325958220931735.
doi: 10.1177/2325958220931735.

Trends and Sex Differences in Access to HIV Care with Scale Up of National HIV Treatment Guidelines in Pune, India

Priyanka Raichur  1 , Sonali Pankaj Salvi  2 , Shashikala Sangle  2 , Amol Chavan  1 , Smita Nimkar  1 , Gajanan Gawande  2 , Bharat Rewari  3 , Jyoti Mathad  4 , Katherine Mcintire  5 , Amita Gupta  1   5 , Ivan Marbaniang  1   6 , Vidya Mave  1   5
Affiliations

Trends and Sex Differences in Access to HIV Care with Scale Up of National HIV Treatment Guidelines in Pune, India

Priyanka Raichur et al. J Int Assoc Provid AIDS Care. 2020 Jan-Dec.

Abstract

Test and treat is the current global standard, yet sex differences persist in access to HIV care. We assessed the differences in presentation and antiretroviral therapy (ART) uptake by sex and ART-eligibility period among ART-naive adults registered at a public ART center in India. Four ART eligibility periods were defined by programmatically determined CD4 criteria (periods I-IV: CD4 <200, <350, ≤500 cells/μL, and any CD4) between January 2005 and December 2017. Of 23 957 participants, 12 510 were male. Men consistently presented with lower median CD4 count (period I-IV, P < .05) and higher median age (period I-III, P < .001) than women. From period I to IV, median age increased in women (P < .0001), ART initiation time decreased in both sexes (P < .001), and median CD4 remained <200 cells/µL in men. Advanced HIV disease and increasing age at presentation are persistent sex-specific trends which warrant innovative HIV testing strategies in both sexes.

Keywords: HIV/AIDS; India; age at presentation; antiretroviral therapy guidelines; sex differences.

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Conflict of interest statement

Declaration of Conflicting Interests: The author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Figures

Figure 1.
Figure 1.
Flowchart showing study population. *Period I: January 1, 2005, to November 3, 2011 (ART eligible if CD4 <200 cells/μL), period II: November 4, 2011, to June 23, 2016 (ART eligible if CD4 <350 cells/μL), period III: June 24, 2016, to May 4, 2017 (ART eligible if CD4 ≤500 cells), and period IV: May 5, 2017, to December 31, 2017 (ART eligible irrespective of CD4 count). ART indicates antiretroviral therapy; SGH, Sassoon General Hospitals.
Figure 2.
Figure 2.
Trends in (A) median age and (B) median CD4 count at presentation by sex and ART eligibility period. A, Higher median age at presentation to HIV care among men (indicated by diamond) than women (indicated by square) during ART eligibility periods I, II, and III (P < .001), but median age increased significantly over the analysis period in women (P = .0001), with no significant sex gap in period IV (test and treat; P = .09). B, Men (indicated by diamond) consistently presented to HIV care with more advanced disease (as indicated by lower median CD4 count) than women (indicated by squares) across all ART eligibility periods. Median CD4 count remained below 200 cells/µL in males and below 300 cells/µL in females throughout the analysis period despite expanding ART provision. *Period I: January 1, 2005, to November 3, 2011 (ART eligible if CD4 <200 cells/μL), period II: November 4, 2011, to June 23, 2016 (ART eligible if CD4 <350 cells/μL), period III: June 24, 2016, to May 4, 2017 (ART eligible if CD4 ≤500 cells), and period IV: May 5, 2017, to December 31, 2017 (ART eligible irrespective of CD4 count).
Figure 3.
Figure 3.
Trends in time to antiretroviral therapy (ART) initiation by sex and ART eligibility period. The median time to ART initiation (indicated by ovals) significantly decreased over the analysis period from 48 to 8 days in men (P < .001) and from 61 to 7 days in women (P < .001). No sex gap is observed in ART eligibility period IV when “test-and-treat” strategy was in effect. *Period I: January 1, 2005, to November 3, 2011 (ART eligible if CD4 <200 cells/μL), period II: November 4, 2011, to June 23, 2016 (ART eligible if CD4 <350 cells/μL), period III: June 24, 2016, to May 4, 2017 (ART eligible if CD4 ≤500 cells), and period IV: May 5, 2017, to December 31, 2017 (ART eligible irrespective of CD4 count).
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