S Chawla1, K Shringarpure2, B Modi3, R Sharma4, B B Rewari5, A N Shah6, P B Verma1,3, A R Dongre7, A M V Kumar8,9. 1. Gujarat State AIDS Control Society, Health and Family Welfare Department, Government of Gujarat, Ahmedabad, India. 2. Department of Community Medicine, Government Medical College and SSG Hospital, Vadodara, India. 3. Department of Community Medicine, Gujarat Medical Education and Research Society (GMERS) Medical College, Gandhinagar, India. 4. Department of Community Medicine, GMERS Medical College, Sola, Ahmedabad, India. 5. World Health Organization India Country Office, New Delhi, India. 6. Department of Medicine, BJ Medical College and Civil Hospital, Ahmedabad, India. 7. Department of Community Medicine, Sri Manakula Vinayagar Medical College and Hospital, Puducherry, India. 8. International Union Against Tuberculosis and Lung Disease (The Union), South-East Asia Office, New Delhi, India. 9. The Union, Paris, France.
Abstract
Setting: Five purposively selected antiretroviral therapy (ART) centres in Gujarat, India. Objectives: To assess the proportion of ART-eligible people living with the human immunodeficiency virus (PLHIV) who were not initiated on ART within 2 months of being recorded as eligible, to identify factors associated with non-initiation and to explore reasons from the provider's perspective. Design: We used a mixed-methods design (triangulation) of 1) a quantitative phase involving record reviews and cohort analysis (Poisson regression) of PLHIV registered during April 2014-March 2015, and 2) a qualitative phase involving one-to-one interviews with 25 providers. Results: Of 2079 ART-eligible PLHIV, 339 (16%) were not started on ART within 2 months. PLHIV with CD4 counts of <350 cells/μl and patients who were labourers, hospitalised, bedridden or registered with certain ART centres were more likely not to be initiated on ART. Qualitative results were categorised into two broad themes: government health system- and patient-related challenges, which validated and complemented the quantitative findings. Conclusion: Several patient subgroups at greater risk of ART non-initiation were identified, along with reasons for risk; this has important programme implications for achieving the UNAIDS 90-90-90 goal, and particularly the second 90 component of having 90% of diagnosed PLHIV start ART.
Setting: Five purposively selected antiretroviral therapy (ART) centres in Gujarat, India. Objectives: To assess the proportion of ART-eligible people living with the human immunodeficiency virus (PLHIV) who were not initiated on ART within 2 months of being recorded as eligible, to identify factors associated with non-initiation and to explore reasons from the provider's perspective. Design: We used a mixed-methods design (triangulation) of 1) a quantitative phase involving record reviews and cohort analysis (Poisson regression) of PLHIV registered during April 2014-March 2015, and 2) a qualitative phase involving one-to-one interviews with 25 providers. Results: Of 2079 ART-eligible PLHIV, 339 (16%) were not started on ART within 2 months. PLHIV with CD4 counts of <350 cells/μl and patients who were labourers, hospitalised, bedridden or registered with certain ART centres were more likely not to be initiated on ART. Qualitative results were categorised into two broad themes: government health system- and patient-related challenges, which validated and complemented the quantitative findings. Conclusion: Several patient subgroups at greater risk of ART non-initiation were identified, along with reasons for risk; this has important programme implications for achieving the UNAIDS 90-90-90 goal, and particularly the second 90 component of having 90% of diagnosed PLHIV start ART.
Entities:
Keywords:
90–90–90; ART-eligible; National AIDS Control Programme; SORT IT; operational research
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