Health Economics and Epidemiology Research Office, Department of Internal Medicine, School of Clinical Medicine, Faculty of Health Sciences, University of the Witwatersrand, 39 Empire Road, Empire Park, Parktown, Johannesburg, 2193, South Africa.
Department of Epidemiology, Boston University School of Public Health, Boston, MA, USA.
AIDS Behav. 2021 Sep;25(9):2779-2792. doi: 10.1007/s10461-021-03171-6. Epub 2021 Feb 3.
We aimed to examine the correlates of antiretroviral therapy (ART) deferral to inform ART demand creation and retention interventions for patients diagnosed with HIV during the Universal Test and Treat (UTT) policy in South Africa. We conducted a cohort study enrolling newly diagnosed HIV-positive adults (≥ 18 years), at four primary healthcare clinics in Johannesburg between October 2017 and August 2018. Patients were interviewed immediately after HIV diagnosis, and ART initiation was determined through medical record review up to six-months post-test. ART deferral was defined as not starting ART six months after HIV diagnosis. Participants who were not on ART six-months post-test were traced and interviewed telephonically to determine reasons for ART deferral. Modified Poisson regression was used to evaluate correlates of six-months ART deferral. We adjusted for baseline demographic and clinical factors. We present crude and adjusted risk ratios (aRR) associated with ART deferral. Overall, 99/652 (15.2%) had deferred ART by six months, 20.5% men and 12.2% women. Baseline predictors of ART deferral were older age at diagnosis (adjusted risk ratio (aRR) 1.5 for 30-39.9 vs 18-29.9 years, 95% confidence intervals (CI): 1.0-2.2), disclosure of intentions to test for HIV (aRR 2.2 non-disclosure vs disclosure to a partner/spouse, 95% CI: 1.4-3.6) and HIV testing history (aRR 1.7 for > 12 months vs < 12 months/no prior test, 95% CI: 1.0-2.8). Additionally, having a primary house in another country (aRR 2.1 vs current house, 95% CI: 1.4-3.1) and testing alone (RR 4.6 vs partner/spouse support, 95% CI: 1.2-18.3) predicted ART deferral among men. Among the 43/99 six-months interviews, women (71.4%) were more likely to self-report ART initiation than men (RR 0.4, 95% CI: 0.2-0.8) and participants who relocated within SA (RR 2.1 vs not relocated, 95% CI: 1.2-3.5) were more likely to still not be on ART. Under the treat-all ART policy, nearly 15.2% of study participants deferred ART initiation up to six months after the HIV diagnosis. Our analysis highlighted the need to pay particular attention to patients who show little social preparation for HIV testing and mobile populations.
我们旨在研究抗逆转录病毒治疗（ART）延迟的相关因素，为南非普遍检测和治疗（UTT）政策下诊断出 HIV 的患者提供 ART 需求创造和保留干预措施。我们开展了一项队列研究，在约翰内斯堡的四个初级保健诊所招募了新诊断为 HIV 阳性的成年人（≥ 18 岁）。在 HIV 诊断后立即对患者进行访谈，并通过医疗记录审查确定 ART 起始时间，直至检测后六个月。ART 延迟定义为 HIV 诊断后六个月未开始 ART。对未在检测后六个月开始 ART 的参与者进行追踪并通过电话进行访谈，以确定 ART 延迟的原因。使用校正泊松回归评估与 ART 延迟相关的因素。我们调整了基线人口统计学和临床因素。我们呈现了与 ART 延迟相关的未校正风险比（crude risk ratio，CRR）和校正风险比（adjusted risk ratio，aRR）。总体而言，99/652（15.2%）名患者在六个月后延迟了 ART 治疗，其中 20.5%为男性，12.2%为女性。ART 延迟的基线预测因素包括诊断时年龄较大（30-39.9 岁 vs 18-29.9 岁的调整风险比[aRR]为 1.5，95%置信区间[CI]：1.0-2.2）、透露 HIV 检测意向（aRR 2.2 不透露 vs 透露给伴侣/配偶，95% CI：1.4-3.6）和 HIV 检测史（aRR 1.7 ＞12 个月 vs ＜12 个月/无既往检测，95% CI：1.0-2.8）。此外，在另一个国家拥有主要住房（aRR 2.1 vs 当前住房，95% CI：1.4-3.1）和独自检测（RR 4.6 vs 伴侣/配偶支持，95% CI：1.2-18.3）预测了男性的 ART 延迟。在 43/99 名六个月访谈中，女性（71.4%）自我报告开始 ART 的可能性高于男性（RR 0.4，95% CI：0.2-0.8），在南非境内搬迁的参与者（RR 2.1 vs 未搬迁，95% CI：1.2-3.5）仍未开始 ART 的可能性更高。在普遍治疗的 ART 政策下，近 15.2%的研究参与者在 HIV 诊断后长达六个月才开始 ART 治疗。我们的分析强调，需要特别关注对 HIV 检测准备不足和流动人口的患者。
