title: Determinants of treatment access in a population-based cohort of HIV-positive men and women living in Argentina.
abstract: OBJECTIVE
  To report emerging data on the use of highly active antiretroviral therapy (HAART) in Argentina by assessing patterns of HAART access and late vs early treatment initiation in a population-based cohort of adults infected with HIV type-1.
  
  
  METHODS
  The Prospective Study on the Use and Monitoring of Antiretroviral Therapy (PUMA) is a study of 883 HIV-positive individuals enrolled in the Argentinean drug treatment program. Individuals were 16 years of age and older and were recruited from 10 clinics across Argentina.
  
  
  METHODS
  Sociodemographic and clinical characteristics were examined using contingency tables (Pearson chi-square test and Fisher exact test) for categoric variables and Wilcoxon rank-sum test for continuous variables. To analyze time to initiation of HAART we used Kaplan-Meier methods and Cox regression.
  
  
  RESULTS
  Patients who initiated HAART were more likely to be older, have an AIDS-defining illness, be an injection drug user (IDU), have a lower median CD4 cell count, have a higher median viral load, and be less likely to be men who have sex with men (MSM). In multivariate analysis, AIDS-defining illness and plasma viral load were significantly associated with time to starting therapy. Patients who received late access were more likely to be diagnosed with AIDS and have higher median plasma viral loads than those receiving early access.
  
  
  CONCLUSIONS
  Our results indicate that despite free availability of treatment, monitoring, and care in Argentina, a significant proportion of men and women are accessing HAART late in the course of HIV disease. Further characterization of the HIV-positive population will allow for a more comprehensive evaluation of the impact of HAART within the Argentinean drug treatment program.
authors.affiliation: Fundacion Dra. Cecilia Grierson, Buenos Aires, Argentina. carlos.zala@aclires.com
authors.forename: Carlos
authors.initials: C
authors.lastname: Zala
authors.forename: Clare A
authors.initials: CA
authors.lastname: Rustad
authors.forename: Keith
authors.initials: K
authors.lastname: Chan
authors.forename: Nabeela I
authors.initials: NI
authors.lastname: Khan
authors.forename: Marcelo
authors.initials: M
authors.lastname: Beltran
authors.forename: Eduardo
authors.initials: E
authors.lastname: Warley
authors.forename: Mariana
authors.initials: M
authors.lastname: Ceriotto
authors.forename: Eric F
authors.initials: EF
authors.lastname: Druyts
authors.forename: Robert S
authors.initials: RS
authors.lastname: Hogg
authors.forename: Julio
authors.initials: J
authors.lastname: Montaner
authors.forename: Pedro
authors.initials: P
authors.lastname: Cahn
mesh_terms: D000328:Adult; D023241:Antiretroviral Therapy, Highly Active / Q000706:statistics & numerical data*; D001118:Argentina / Q000453:epidemiology; D005260:Female; D015658:HIV Infections / Q000453:epidemiology* / Q000517:prevention & control*; D015497:HIV-1; D006297:Health Services Accessibility / Q000706:statistics & numerical data*; D006801:Humans; D008297:Male; D015995:Prevalence; D018570:Risk Assessment / Q000379:methods*; D012307:Risk Factors; D012959:Socioeconomic Factors