2012 Articles

Factors Associated with Late Antiretroviral Therapy Initiation among Adults in Mozambique

Lahuerta Sanau, Maria; Nuwagaba-Biribonwoha, Harriet; Okamura, Mie; Alvim, Maria Fernanda; Fernandes, Rufio; Assan, Americo; Hoos, David; Elul, Batya O.; El-Sadr, Wafaa Mahmoud; Nash, Denis; Lima, Josue

Despite recent changes to expand the ART eligibility criteria in sub-Saharan Africa, many patients still initiate ART in the advanced stages of HIV infection, which contributes to increased early mortality rates, poor patient outcomes, and onward transmission. To evaluate individual and clinic-level factors associated with late ART initiation in Mozambique, we conducted a retrospective sex-specific analysis of data from 36,411 adult patients who started ART between January 2005 and June 2009 at 25 HIV clinics in Mozambique. Late ART initiation was defined as CD4 count>100 cells/µL or WHO stage IV. Mixed effects models were used to identify patient- and clinic-level factors associated with late ART initiation.The risk of starting ART late remained persistently high. Efforts are needed to ensure identification and enrollment of patients at earlier stages of HIV disease. Individual and clinic level factors identified may provide clues for upstream structural interventions.