Factors Associated With Late Antiretroviral Therapy Initiation Among People Living With HIV in Southern Iran: A Historical Cohort Study

Afrashteh, Sima; Fararouei, Mohammad; Ghaem, Haleh; Gheibi, Zahra

doi:10.3389/fpubh.2022.881069

Cited by 5 publications

(11 citation statements)

References 26 publications

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“…The study also demonstrated that males were associated with delayed ART-initiation. This finding, however, differs with studies from Canada (Joseph, et al, 2016) and the US [105] where no association between gender and time-to-ART-initiation was observed and from southern Iran study which reported no association between gender and treatment initiation times [103]. However, studies from Zimbabwe [106], Ethiopia [107], and Cameroon [108], reported that male gender was a risk factor for late-ART-presentation – therefore, a barrier to rapid treatment-initiation.…”

Section: Discussioncontrasting

confidence: 84%

“…(aOR: 1.8, 95%CI:1.17-2.78) [103] as was also reported in China [104]. This study also found that dependency on guardian escort was 9% negatively associated with early ARTinitiation.…”

Section: A D J U S T E D H a Z A R D R A T I O F O R T T A T -I N I T...supporting

confidence: 84%

“…The current study finding on younger age Vs TTAT are in congruent with West African multinational study reported that younger age (of at least 24 years) was associated with early ART-initiation [94] – a similar association was also observed from South African KwaZulu Natal study [102]. The KwaZulu Natal study reported that early mid-age (of 35-44 years) had a 63% positive association with early ART-initiation (in males) and 90% probability (in females) whereas being ≥45 years old was a barrier to early ART-initiation [102] – the findings also shared in a study from Iran where old age was reported to be significantly associated with risk of late ART-initiation [aOR:1.02, 95%CI:(1.00-1.04)] [103] and a similar pattern was also observed from China [104].…”

Section: Discussionmentioning

confidence: 89%

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Predictors of Time-to-ART-Initiation Survival Times in a Random Sample of Adults Living with HIV from Malawi – A Historical, Nationally Representative Cohort Sample of 2004-2015 HIV Data

Salema

2024

Preprint

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BackgroundDespite globally adapted universal test-and-treat (UTT) strategy of HIV management, survival time-to-antiretroviral-therapy initiation (TTAT) remains heterogenous and affected by diverse factors which remain unexplained in Malawi. This study explored correlates to TTAT-initiation in Malawi among adults living with HIV.MethodsA multicentre retrospective cohort study was undertaken from eight centres. Medical records of (n=9,953) adult patients aged 15+ years old, were reviewed. A life table, the Kaplan-Meier log-rank, and Cox Proportion Hazard regression were used to calculate survival TTAT-initiation and its correlates, respectively. Adjusted Hazard ratio less than 1 (aHR <1) signified factors negatively associated, while aHR >1 meant factors positively associated with TTAT-initiation. Hazard ratio with 95% Confidence interval (95%CI) andp<0.05 were used to declare statistical significance.ResultsData from (n=9,953) adult HIV patients were abstracted from hospital medical records. Patients median age was 40 (IQR: 33-48 years). 60.8% were females, 45.2% were younger adults of 20-39 years, and 78.8% were either married or cohabiting. 48.1% had advanced HIV disease; WHO clinical stage III, 24.5% had WHO stage IV, whereas 27.5% were asymptomatic; thus; 24.9% initiated ART due to low CD4+ count and 2.6% under PMTCT’s Option-B+. Findings from TTAT-initiation survival function analysis show that each patient had a single entry into the study and provided a total of 5,414 event-time-intervals, giving a 100% total event-failure without censored observations. Mean and median survival times were 527.2 days and 6 (IQR 0-5,414) days, respectively. Treatment-initiation (time at risk) was observed at the rate of 0.002 per 5,247,268 person-years. From multivariable Cox PH regression analysis, independent factors identified to be negatively associated with early (timely) antiretroviral treatment-initiation included; older age of 55+ years by 16% [aHR 0.84, 95%CI: (0.71–0.97)], male gender by 4% [aHR=0.96, 95%CI: (0.92–0.98)], bacterial causes by 5% [aHR=0.95, 95%CI: (0.89–0.99)], mycobacterial causes by 14% [aHR=0.86, 95%CI: (0.81–0.92)], high viraemia VL>1,000 copies/mL by 17% [aHR=0.83, 95%CI: (0.81–0.95)], registered in secondary tier and tertiary tier health facilities by 21% [aHR 0.79, 95%CI: (0.73-0.86) and 14% [aHR 0.86, 95%CI: (0.79-0.93) respectively, longer HIV survivorship (duration) by 58% to 85%, and having respiratory symptoms like coughing or breathlessness by 7% [0.93 95%CI: (0.88–0.97)]. These factors acted as barriers to early time-to-ART-initiation. In contrast younger adults of 20-39 years; [aHR=1.04, 95%CI: (1.02–1.19)], early mid-aged patients of 40-54 years; [aHR=1.03, 95%CI: (1.01– 1.21)], incomplete basic education level; [aHR 1.09, 95%CI: (1.02-1.20)], secondary education level; [aHR=1.06, 95%CI: (1.01-1.12)], Northern and Southern regions ethnicity; [aHR=1.07, 95%CI: (1.02–1.16)] and [aHR=1.06, 95%CI: (1.01–1.12) respectively, manifesting chronic headache or fevers; [aHR=1.12, 95%CI: (1.04–1.21)], being asymptomatic; [aHR=1.02, 95%CI: (1.02–1.13), (p<0.041)], being immunosuppressed with WHO clinical stage III; [aHR=1.86, 95%CI: (1.21-3.45)], WHO clinical stage IV; [aHR=2.80, 95%CI: (1.20-3.22)], protozoal pathological infection; [aHR=1.06, 95%CI: (1.02-1.15)], low CD4+ cell count <250 cells/µL; [aHR=1.05, 95%CI: (1.01–1.09), self-employment [aHR=1.04, 95%CI: (1.00–1.09)], and year of HIV diagnosis variable, were all positively associated with treatment-initiation and acted as precursors to early (timely) ART-initiation.ConclusionThe study demonstrates that apart from meeting clinical eligible, different clinical and nonclinical factors contributed to time-to-treatment initiation among adults living with HIV. These factors; which are still prevalent in Malawi, have contributed to the spiralling and high mortality and morbidity from HIV/AIDS in Malawi and– hence, a knowledge of their existence, coupled with efforts to counteract and halt their occurrences, and strategies to strengthen and sustain the gained milestones in all tiers of health facility establishments across Malawi cannot be overemphasised.

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Section: Discussioncontrasting

confidence: 84%

“…(aOR: 1.8, 95%CI:1.17-2.78) [103] as was also reported in China [104]. This study also found that dependency on guardian escort was 9% negatively associated with early ARTinitiation.…”

Section: A D J U S T E D H a Z A R D R A T I O F O R T T A T -I N I T...supporting

confidence: 84%

Section: Discussionmentioning

confidence: 89%

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Predictors of Time-to-ART-Initiation Survival Times in a Random Sample of Adults Living with HIV from Malawi – A Historical, Nationally Representative Cohort Sample of 2004-2015 HIV Data

Salema

2024

Preprint

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“…We found that patients who diagnosed after 2016 had a shorter duration to initiate ART compared to those diagnosed before 2016. In accordance with this finding, a study from southern Iran on 1,326 adult HIV patients showed that initiating ART during 2011–2013 had 3.65 odds [95% CI 2.28, 5.86] for late ART initiation compared to more recent years (2018–2021) 38 . Additionally, Lahuerta et al 28 and Ndawinz et al 39 found that patients initiating ART in recent calendar years had lower odds of late ART initiation Moreover, a study from China showed a constant decline in delayed ART initiation from 2010 to 2020, with a sharp decrease in 2016 (58.0% to 36.9%), coinciding with national guideline reforms 40 .…”

Section: Discussionsupporting

confidence: 61%

“…A study on 1180 Ethiopian adults found that being male was associated with higher odds of late ART initiation (aOR: 2.02 [95% CI 1.50, 2.73]) 42 . Another study in Iran also observed similar findings (OR: 0.41 [95% CI 0.31, 0.55]) 38 . The lower likelihood of late ART initiation in females could be justified by routine testing and care during antenatal visits provided by Prevention of Mother to Child Transmissions (PMTCT) services 43 – 45 , and differences in health-seeking behavior 46 .…”

Section: Discussionsupporting

confidence: 61%

Factors associated with late initiation of antiretroviral therapy in Iran’s HIV/AIDS surveillance data

sharafi,

Mirahmadizadeh,

Hassanzadeh

et al. 2024

Sci Rep

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Early initiation of Antiretroviral Treatment (ART) in HIV patients is essential for effectively suppressing the viral load and prognosis. This study utilized National HIV/AIDS Surveillance Data in Iran to identify factors associated factors with the duration to initiate ART. This hybrid cross-sectional historical cohort study was conducted on Iran’s National HIV/AIDS Surveillance Data from 2001 to 2019. Sociodemographic characteristics, route of transmission, HIV diagnosis date, and ART initiation date were collected. Multivariable linear and quantile regression models were employed to analyze the duration to initiate ART by considering predictor variables. This study included 17,062 patients (mean age 34.14 ± 10.77 years, 69.49% males). Multivariate quantile regression coefficients varied across different distributions of the dependent variable (i.e., duration to initiate ART) for several independent variables. Generally, male gender, injecting drug use (IDU), and having an HIV-positive spouse were significantly associated with an increased duration to initiate ART (p < 0.05). However, a significant decrease was observed in older patients, those with a university level education, men who had sex with men (MSM), and patients diagnosed after 2016 (p < 0.05). Despite improvements in the duration to initiate ART after implementing the WHO’s 2016 program in Iran, various sociodemographic groups were still vulnerable to delayed ART initiation in the region. Therefore, programs including early testing, early ART initiation, active care, educational and cultural interventions, and appropriate incentives are required for these groups.

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Factors Associated with Immediate Antiretroviral Therapy Initiation Among Newly Diagnosed People Living with HIV in Guangdong Province, China

Huang,

Liu,

Lin

et al. 2023

AIDS Patient Care and STDs

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Factors Associated With Late Antiretroviral Therapy Initiation Among People Living With HIV in Southern Iran: A Historical Cohort Study

Cited by 5 publications

References 26 publications

Predictors of Time-to-ART-Initiation Survival Times in a Random Sample of Adults Living with HIV from Malawi – A Historical, Nationally Representative Cohort Sample of 2004-2015 HIV Data

Predictors of Time-to-ART-Initiation Survival Times in a Random Sample of Adults Living with HIV from Malawi – A Historical, Nationally Representative Cohort Sample of 2004-2015 HIV Data

Factors associated with late initiation of antiretroviral therapy in Iran’s HIV/AIDS surveillance data

Factors Associated with Immediate Antiretroviral Therapy Initiation Among Newly Diagnosed People Living with HIV in Guangdong Province, China

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