Division of Women's Health and Infectious Diseases, Brigham and Women's Hospital, Boston, Massachusetts 02120, USA.
AIDS. 2011 Nov 13;25(17):2177-81. doi: 10.1097/QAD.0b013e32834b6464.
To determine rates and predictors of treatment refusal in newly identified HIV-infected individuals in Soweto, South Africa.
It is designed as a cross-sectional study.
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.
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.
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.
在南非索韦托新发现的 HIV 感染者中，确定治疗拒绝率及其预测因素。
这是一项横断面研究。
我们分析了在 Zazi 检测中心，围产期 HIV 研究单位接受自愿咨询和检测（VCT）的成年患者（>18 岁）的数据，以确定符合治疗条件的 HIV 感染者（CD4（+）细胞计数<200 个/μl 或 WHO 分期 4）中抗逆转录病毒治疗（ART）的拒绝率。采用多因素逻辑回归模型来探讨与拒绝相关的因素。
2008 年 12 月至 2009 年 12 月，7287 名成人接受了咨询后 HIV 检测。2562 人（35%）HIV 阳性，其中 743 人（29%）符合立即开始 ART 的条件。148 人（20%）拒绝转介开始 ART，其中大多数人（92%）在咨询后 2 个月仍拒绝。拒绝 ART 的主要原因是“感觉健康”（37%），尽管患者的 CD4（+）细胞计数中位数为 110 个/μl，而且结核病的发生率是未拒绝者的三倍。在调整模型中，单身患者（调整优势比[OR]1.80，95%置信区间[CI]1.06-3.06）和患有结核病的患者（OR 3.50，95%CI 1.55-6.61）更有可能拒绝 ART。
在索韦托，近五分之一符合治疗条件的 HIV 感染者在 VCT 后拒绝开始 ART，这使他们面临更高的早期死亡率风险。尽管 CD4（+）计数降低且存在结核病等合并症，但“感觉健康”是拒绝 ART 的最常见原因。这些发现强调迫切需要研究以提供信息，从而制定针对 ART 拒绝者的干预措施。
