Factors associated with delayed and late ART initiation among people living with HIV in BC: results from the engage study

ABSTRACT

We examined correlates of late and delayed initiation of antiretroviral therapy (ART) in British Columbia, Canada. From December 2013 to December 2015 we recruited treatment-naïve people living with HIV who initiated ART within the previous year. ‘Late initiation’ was defined as CD4 cell count ≤500 cells/µL at ART initiation and ‘delayed initiation’ as ≥1 year between HIV diagnosis and initiation. Multivariable logistic regression assessed independent correlates of late and delayed initiation. Of 87 participants, 44 (51%) initiated late and 22 (26%) delayed initiation. Delayed initiation was positively associated with older age (adjusted odds ratio [AOR]: 1.06 per year, 95% confidence interval [95% CI]: 1.01–1.12) and inversely associated with wanting to start ART at diagnosis (AOR: 0.06, 95% CI: 0.02–0.21). Variables associated with late initiation were older age (AOR: 1.09 per year, 95% CI: 1.03–1.15) and medical reason(s) for initiation (AOR: 5.00, 95% CI: 1.41–17.86). Late initiation was less likely among those with greater perceived ART efficacy (AOR 0.94, 95% CI: 0.90–0.98) and history of incarceration (AOR: 0.12, 95% CI: 0.03–0.56). Disparities in timing of initiation were observed for age, perceived ART efficacy, and history of incarceration. Enhanced health services that address these factors may facilitate earlier treatment initiation.

KEYWORDS:

• HIV
• ART
• treatment initiation
• linkage to care

Acknowledgements

We would like to thank all of the participants for their time, and our community and academic study partners, including Dr. Mary Kestler and Ms. Rosalind Baltzer-Turje, and the staff at the BC Centre for Excellence in HIV/AIDS, particularly Mr. Paul Sereda, for their contributions to this study. R.S.H. and D.M.M. conceived of and designed the study. Z.C. and J.C. performed all statistical analyses. S.K., S.P., and C.O. drafted the manuscript. D.M.M. and R.S.H. advised on all aspects of the study. All authors reviewed the manuscript critically and approved the final version submitted for publication.

Disclosure statement

DMM is supported by a Scholar Award from the Michael Smith Foundation for Health Research. HS is supported by a Michael Smith Foundation for Health Research Postdoctoral Fellowship. JSGM is supported with grants paid to his institution by the British Columbia Ministry of Health and by the US National Institutes of Health (R01DA036307). He has also received limited unrestricted funding, paid to his institution, from Abbvie, Bristol-Myers Squibb, Gilead Sciences, Janssen, Merck, and ViiV Healthcare. For the remaining authors, no competing interests were declared.

ORCID

Zishan Cui http://orcid.org/0000-0002-9236-3890

Robert S. Hogg http://orcid.org/0000-0003-3463-5488

Additional information

Funding

The Engage Study is funded by the Canadian Institutes of Health Research through an Operating Grant in Public, Community & Population Health [grant number 259240]. The study funder had no role in study design, data collection, data analysis, data interpretation, or writing of this manuscript.