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Factors associated with advanced HIV disease at ART initiation among adults in HIV care and treatment programs in Mozambique
D. Nash1, M. Lamb1, M.F. Alvim2, M. Okamura2, H. Nuwagaba-Biribonwoha3, B. Elul1, C. Xavier2, A. Assan4, J. Lima2, W. El Sadr1, D. Arakaki-Sanchez2
1Columbia University - Mailman School of Public Health, International Center for AIDS Care and Treatment Programs (ICAP), New York, United States, 2International Center for AIDS Care and Treatment Programs (ICAP), Mozambique, Maputo, Mozambique, 3Columbia University - Mailman School of Public Health, International Center for AIDS Care and Treatment Programs (ICAP), Kampala, Uganda, 4Mozambican Ministry of Health, National Directorate of Medical Assistance (DAM), Maputo, Mozambique
Background: Late ART initiation is associated with increased risk of early mortality in sub-Saharan Africa, underscoring the need to gain a better understanding of the factors associated with advanced HIV disease at ART initiation.
Methods: We used data from 20 HIV care and treatment sites in the national HIV care and treatment program on patients who initiated ART during January 2005-December 2008. Multiple logistic regression was used to examine factors associated with advanced HIV disease at ART initiation, defined as having a CD4 count < 100 cells/µL or WHO Stage IV.
Results: Of 24,336 eligible patients who initiated ART, 12,746 (52%) had advanced HIV disease (range across sites 44%-64%); this proportion decreased over time (55%, 51%, 44%, and 47% in 2005-2008, respectively). Of the 12,746 with advanced HIV at ART initiation, 36% had WHO IV (range across sites 10%-65%) and 64% had CD4< 100 cells/µL without evidence of WHO IV (median CD4: 49 cells/µL, range across sites 22-76 cells/µL). Factors independently associated with a lower odds of advanced HIV at ART initiation included entering care via a PMTCT program (adjusted odds ratio [aOR]=0.5, 95% confidence interval [CI]I=0.4-0.6), age>50 (aOR=0.8, 95%CI=0.7-0.9), and later calendar year of ART initiation (aOR2008 vs. 2005= 0.8 (95% CI = 0.7-0.9). Factors associated with increased odds included male sex (aOR = 1.5, 95% CI = 1.4-1.6), and lower weight at ART initiation (aOR< 40 vs. > 40kg=2.1, 95%CI=1.8-2.3),.
Conclusions: While improvements over time were observed, a substantial proportion of patients continue to initiate ART at advanced stages of HIV disease. Earlier enrollment into HIV care and strengthening linkages with PMTCT programs may enable ART initiation at earlier stages of HIV disease.
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