Determinants for late antiretroviral therapy initiation among diagnosed HIV positive individuals in Alebtong District, Uganda: A cross-sectional study

Abstract

Background: Antiretroviral Therapy (ART) greatly reduces Human Immuno-deficiency Syndrome (HIV) related morbidity and mortality among HIV patients. However, global ART coverage for adults was only 38% and 46% by the end of 2013 and 2015 respectively. Gains were greatest in the world’s most affected region, Eastern and Southern Africa where coverage increased from 24% in 2010 to 54% in 2015. Despite these successes, late ART initiation remains a significant challenge in improvement HIV treatment in sub-Saharan Africa including Uganda. Objective: The objective of this study was to determine the proportion and factors associated with late ART initiation among adults diagnosed with HIV in Alebtong district, Uganda. Methods: The study used a cross-sectional study design which included adults 18 years and above who were diagnosed with HIV and medical staff working in ART clinics. It was conducted in seven health facilities between April 2017 and March 2018 in Alebtong district. All the health facilities offering ART services were included in the study. Respondents were interviewed after systematically sampling them. Structured questionnaires, structured checklists and data extraction tools were used to collect quantitative data. The outcome was measured as a binary variable (i.e. early and late ART initiation). Data analysis was performed using SPSS statistics version 23.0 where univariable, bivariable and multivariable analyses were conducted. Odds Ratio was used as a measure of association at 95% CI and p<0.05. Results: The proportion of late ART initiation was 18.1% (78/432). Majority of the respondents were female, 60.9% (263/432) and 93.8% (405/432) of them were living in rural areas. Most respondents were 35 years or less (67.8% (293/432) and married, 73.4% (317/432). Adjusted analysis showed that younger age (aOR = 0.35 & 95% CI: 0.16-0.76), primary level of education (aOR = 0.04 & 95% CI: 0.05-0.35); non-adherence to facility appointment (aOR = 0.06 & 95% CI: 0.02-0.15); low socioeconomic status (aOR = 0.27 & 95% CI: 0.07-0.98), experience of stigma (aOR = 3.47 & 95% CI: 1.02-11.79) and lack of linkage to HIV care the same day tested (aOR = 0.21 & 95% CI: 0.08-0.55) were significantly associated with late ART initiation. Conclusions: Careful consideration of factors associated with late ART and managing these factors may improve ART initiation, treatment outcomes and reduce the risk of premature mortality and further HIV transmission in Uganda.