Résumé
Many people living with HIV/AIDS in resource-limited settings begin antiretroviral therapy (ART) at low CD4 counts. Here, we investigated the simultaneous effect of individual-, facility- and regional-level factors on late ART initiation.
We conducted a survey in a nationally representative sample of 55 HIV treatment facilities in Cameroon. Medical records of 4935 patients 15 years of age who initiated ART in the month of October during the period 200710 were reviewed to gather individual characteristics. Late ART initiation was defined as CD4 count 100 cells/mm(3). Facility- and regional-level characteristics were also collected. Two-level regression logistic models were used to identify factors associated with late ART initiation.
Late ART initiation was associated with being a male younger than 45 years versus female younger than 45 years [adjusted OR (AOR)1.5, 95 CI: 1.31.7] and initiating ART in the period 200709 versus 2010 (AOR1.2, 95 CI: 1.01.4). Late initiation was more likely in central than in district hospitals (AOR1.3, 95 CI: 1.11.6) and in hospitals without a mother-to-child transmission programme (AOR1.9, 95 CI: 1.32.8). Living in a region with a higher comprehensive knowledge of HIV/AIDS was associated with not initiating ART late (AOR0.8, 95 CI: 0.61.0).
This study shows that risk factors associated with late ART initiation operate at multiple levels and that multilevel interventions are therefore necessary to promote earlier HIV testing and treatment.