ART initiation among women newly diagnosed with HIV in a contraceptive trial in sub-Saharan Africa

ABSTRACT

Current guidelines recommend starting antiretroviral therapy (ART) as soon as possible after HIV diagnosis to reduce morbidity, mortality and onward HIV transmission. We examined factors influencing ART initiation by women who seroconverted during the Evidence for Contraceptive Options and HIV Outcomes (ECHO) Trial. ECHO, conducted between 2015 and 2018, enrolled HIV-negative, sexually active women, aged 16–35 years, from four African countries. Follow-up was 12–18 months, with quarterly HIV testing. Women with incident HIV infection received extensive counselling by trial staff and referral to local facilities for HIV care. Of 304 women with ≥90 days follow-up time since HIV diagnosis, 186(61.2%) initiated ART within 90 days, 69(22.7%) initiated after 90 days, and 49(16.1%) had not initiated by the end of the study. There were no statistically significant differences in characteristics among women who initiated ART ≤90 days versus those who did not. Frequent reasons for delayed or non-initiation of ART included not feeling ready to start ART and being newly diagnosed. In a large clinical trial, ART initiation was modest within 90 days of HIV diagnosis and grew to 84% with longer observation. Despite extensive counselling on the importance of early ART initiation, personal barriers delayed some women from starting ART.

KEYWORDS:

• Antiretroviral therapy (ART)
• women
• clinical trials
• ART initiation
• delayed ART initiation

Acknowledgments

We thank the women that participated in the ECHO Trial for their dedication and commitment to the trial. We are also grateful to the trial staff including the counsellors, nurses and clinicians for the clinical care provided to women in the trial.

Disclosure statement

No potential conflict of interest was reported by the author(s).

Data availability statement

Access to data from the ECHO Trial may be requested through submission of a research concept to [email protected]. The concept must include the research question, data requested, analytic methods, and steps taken to ensure ethical use of the data. Access will be granted if the concept is evaluated to have scientific merit and if sufficient data protections are in place. As of the time of publication, data access applications are in process with the governing institutional review boards of the ECHO Trial to make de-identified data publicly available.

Additional information

Funding

The ECHO Trial was funded by the Bill & Melinda Gates Foundation (Grant OPP1032115), the American people through the United States (US) Agency for International Development (Grant AID-OAA-A-15–00045), the Swedish International Development Cooperation Agency (Grant 2017/762965–0), the United Nations Population Fund, and the Medical Research Council of South Africa. In addition, the US Agency for International Development and the South African government donated the contraceptives that were used in the study. The contents of this paper are solely the responsibility of the authors and do not necessarily reflect the views, decisions, or policies of the institutions with which they are affiliated, the ECHO trial funders, or the supporting governments.