Journal
HIV MEDICINE
Volume 16, Issue 9, Pages 521-532Publisher
WILEY
DOI: 10.1111/hiv.12253
Keywords
adults; antiretroviral agents; HIV; men; rural health services; South Africa; therapeutic initiation; women
Categories
Funding
- United States Agency for International Development (USAID)
- President's Emergency Plan (PEPFAR) [674-A-00-08-00001-00]
- Wellcome Trust, UK [GR065377MA]
- French National Agency for AIDS Research (ANRS)
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ObjectivesAlthough antiretroviral therapy (ART) has been freely available since 2004 in South Africa, not all those who are eligible initiate ART. We aimed to investigate individual and household characteristics as barriers to ART initiation in men and women in rural KwaZulu-Natal. MethodsAdults 16 years old living within a sociodemographic surveillance area (DSA) who accessed the local HIV programme between 2007 and 2011 were included in the study. Individual and household factors associated with ART initiation within 3 months of becoming eligible for ART were investigated using multivariable logistic regression stratified by sex and after exclusion of individuals who died before initiating ART. ResultsOf the 797 men and 1598 women initially included, 8% and 5.5%, respectively, died before ART initiation and were excluded from further analysis. Of the remaining 733 men and 1510 women, 68.2% and 60.2%, respectively, initiated ART3 months after becoming eligible (P=0.34 after adjustment for CD4 cell count). In men, factors associated with a higher ART initiation rate were being a member of a household located <2 km from the nearest HIV clinic and being resident in the DSA at the time of ART eligibility. In women, ART initiation was more likely in those who were not pregnant, in members of a household where at least one person was on ART and in those with a high wealth index. ConclusionsIn this rural South African setting, barriers to ART initiation differed for men and women. Supportive individual- and household-level interventions should be developed to guarantee rapid ART initiation taking account gender specificities.
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