Barriers to starting ART and how they can be overcome: individual and operational factors associated with early and late start of treatment.
OBJECTIVE
Despite expanding access to antiretroviral therapy (ART) in Sub-Saharan Africa, there are few data on patients' perceptions about starting ART to explore issues affecting decisions to start ART in eligible individuals during the ART roll out.


METHODS
We studied patterns of ART uptake for 957 participants in a trial of cryptococcal disease prevention and performed a qualitative cross-sectional study about issues affecting decisions to start ART in this cohort. In-depth interviews (IDIs) were conducted with 48 participants who started ART after variable time on the trial.


RESULTS
Time to starting ART from trial enrolment decreased during the ART roll out (Median 83 days to 68 days). Multiple factors causing delay to ART were reported; awaiting home visit by service provider (P=0.025), domestic issues (P=0.028), moving from area (P≤0.001) and fear of side effects (P=0.013) were statistically significant. In the IDIs, fear of side effects was the strongest factor for delay and observation of health improvement in others on ART was the strongest inducement to start. Information from patients already taking ART was the most valued source of information.


CONCLUSIONS
This study provided novel information about factors encouraging people to start ART early; positive beliefs about ART were the most important. Whilst side effects of ART must not be downplayed, programmes should provide information in a balanced way to prevent unnecessary fear of starting ART. Those already receiving ART were found to be good advocates and should be utilised by ART programmes to educate others.
Imperial College, St Marys Medical School, Norfolk Place, London, UK. r.parkes@imperial.ac.uk
Rosalind
R
Parkes-Ratanshi
Leonard
L
Bufumbo
Barbara
B
Nyanzi-Wakholi
Jonathan
J
Levin
Heiner
H
Grosskurth
David G
DG
Lalloo
Anatoli
A
Kamali
D000328:Adult; D000368:Aged; D019380:Anti-HIV Agents / Q000008:administration & dosage* / Q000009:adverse effects / Q000627:therapeutic use; D023241:Antiretroviral Therapy, Highly Active / Q000523:psychology; D001294:Attitude to Health; D018791:CD4 Lymphocyte Count; D003657:Decision Making; D003906:Developing Countries; D004334:Drug Administration Schedule; D004812:Epidemiologic Methods; D005260:Female; D015658:HIV Infections / Q000188:drug therapy* / Q000276:immunology; D006801:Humans; D008297:Male; D008875:Middle Aged; D010342:Patient Acceptance of Health Care / Q000706:statistics & numerical data*; D012423:Rural Health / Q000706:statistics & numerical data; D014454:Uganda; D055815:Young Adult
D019380:Anti-HIV Agents