Understanding the Reasons for Deferring ART Among Patients Diagnosed Under the Same-Day-ART Policy in Johannesburg, South Africa

Bibliographic Data

ID15337469
AuthorsDorina Onoya (0000-0002-2664-7342, University of the Witwatersrand, corresponding author), Tembeka Sineke (0000-0002-1856-6358, University of the Witwatersrand), Idah Mokhele (0000-0002-8054-0116, University of the Witwatersrand), Joep Bor (0000-0002-5112-8536, Boston University), Matthew P Fox (0000-0002-5132-7818, University of the Witwatersrand), Jacqui Miot (0000-0001-7070-3826, University of the Witwatersrand)
Year2021
Volume25
Issue9
Pages2779-2792
Publication date2021-02-03
Peer ReviewedYes
Open AccessYes
TypeARTICLE
VenueAIDS and Behavior (JOURNAL)
Journal identifiersISSN: 1090-7165 • E-ISSN: 1573-3254
PublisherSpringer Science+Business Media (PUBLISHER • DE)
DOI10.1007/s10461-021-03171-6
PMID33534055
OpenAlexW3126490327
LanguageEN
Citations received3
References cited29

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

Confidence interval · Deferral · Environmental health · Family medicine · Poisson regression · Population · Psychiatry · Psychological intervention · Public health · Relative risk · Test (biology · Adolescent Sexual and Reproductive Health · Demography · HIV, Drug Use, Sexual Risk · HIV/AIDS Research and Interventions · Medicine · Internal Medicine