AUTHOR=Afrashteh Sima , Fararouei Mohammad , Ghaem Haleh , Gheibi Zahra 

TITLE=Factors Associated With Late Antiretroviral Therapy Initiation Among People Living With HIV in Southern Iran: A Historical Cohort Study

JOURNAL=Frontiers in Public Health

VOLUME=Volume 10 - 2022

YEAR=2022

URL=https://www.frontiersin.org/journals/public-health/articles/10.3389/fpubh.2022.881069

DOI=10.3389/fpubh.2022.881069

ISSN=2296-2565

ABSTRACT=Abstract 

Objectives: Late initiation of antiretroviral therapy (ART) is associated with poor outcome among people living with HIV (PLHIV) and higher risk of transmission of infection. This study was conducted to identify the determinants of late ART initiation among PLHIV in Southern Iran.

Methods: A historical cohort study was conducted on 1326 PLHIV of >=15 years of age who were registered with the behavioral diseases counseling center (BDCC) in southern Iran from August 1997 to March 2021. . Late ART initiation was defined as a CD4 cell count <200 cells/mm3 or having a clinical AIDS diagnosis at the time of ART initiation. The required demographic and clinical data were collected from the patients’ medical records. Multiple regression analysis was conducted to define late ART initiation associated factors.

Results: Late ART initiation was found in 81.9% of patients. Based on the results of the multivariate analysis, Controlled for other contributing factors, older age (OR =1.02, 95%CI=1.00-1.04), being single (OR single/ Married =1.80, 95%CI=1.17-2.78), history of drug use (OR yes/ no =1.64, 95%CI=1.02-2.62), year of ART initiation (OR2011-2013/ 2018-2021 =3.65, 95%CI=2.28-5.86), and possible route of transmission (OR drug injection / sexual =7.34, 95%CI=1.16-46.21) were directly associated with the risk of late initiation ART.

Conclusions: These findings show that the prevalence of late ART initiation was alarmingly high. For better infection control and better prognosis of infection, people at high risk need to be provided with timely services (e.g. diagnosis, treatment, training, and social support).
Keywords: Late antiretroviral therapy, HIV, AIDS, Cross-sectional study, Iran