Prevalence and Factors Associated with Delayed Initiation of Antiretroviral Therapy Among People Living with HIV in Nekemte Referral Hospital, Western Ethiopia.

BACKGROUND

Ethiopia has adopted the "Universal Test and Treat" strategy to its national policy in 2016 to put all people living with HIV/AIDS (PLHIV) on antiretroviral therapy (ART) regardless of their World Health Organization (WHO) clinical stage or CD4 cell count level. A significant percentage of PLHIV start therapy has been delayed despite the availability of ART, which results in poor treatment outcomes including HIV-related morbidity and mortality, and continued HIV transmission.

METHODS

This cross-sectional study was conducted to determine the magnitude and associated factors of delayed ART initiation among PLHIV at ART Clinic, Nekemte Referral hospital, Western Ethiopia between January 1, 2020 and March 31, 2020 for the time period of January 1, 2016 to December 31, 2019. A consecutive sampling method was used to recruit 417 study subjects. The collected data were entered into Epi data version 3.1 and exported to STATA version 14 for statistical analysis. Logistic regression analysis was used to identify associated factors with delayed ART initiation among PLHIV. -values<0.05 were used to declare significant association.

RESULTS

A total of 417 PLHIV were included in the study. The mean age of study subjects was 33.49 (SD±9.81) years. The majority of participants attended formal education (77%) and were urban dwellers (82%). One-third (34%) of them initiated ART delayed, beyond 7 days of confirmed HIV diagnosis. Subjects with normal nutritional status (BMI=18.5-24.9kg/m) (AOR=3.12, 95% CI=1.29-7.57; =0.012), CD4 count ≥351cells/mm (AOR=2.89, 95% CI=1.27-6.58; =0.011), tuberculosis (TBC) co-infection (AOR=2.76, 95% CI=1.13-6.70; =0.025), use of traditional treatment (AOR=4.03, 95% CI=2.03-8.00; <0.001) and did not know other ART user(s) (AOR=2.86, 95% CI=1.52-5.37; =0.001) were significantly associated with delayed ART initiation.

CONCLUSION

Early HIV testing mechanisms and timely linkage to HIV care by advocating "Test-and-Treat" should be strengthened.