title: Antiretroviral therapy refusal among newly diagnosed HIV-infected adults.
abstract: OBJECTIVE
  To determine rates and predictors of treatment refusal in newly identified HIV-infected individuals in Soweto, South Africa.
  
  
  METHODS
  It is designed as a cross-sectional study.
  
  
  METHODS
  We analyzed data from adult clients (>18 years) presenting for voluntary counseling and testing (VCT) at the Zazi Testing Center, Perinatal HIV Research Unit to determine rates of antiretroviral therapy (ART) refusal among treatment-eligible, HIV-infected individuals (CD4(+) cell count < 200 cells/μl or WHO stage 4). Multiple logistic regression models were used to investigate factors associated with refusal.
  
  
  RESULTS
  From December 2008 to December 2009, 7287 adult clients were HIV tested after counseling. Two thousand, five hundred and sixty-two (35%) were HIV-infected, of whom 743 (29%) were eligible for immediate ART. One hundred and forty-eight (20%) refused referral to initiate ART, most of whom (92%) continued to refuse after 2 months of counseling. The leading reason for ART refusal was given as 'feeling healthy' (37%), despite clients having a median CD4(+) cell count of 110 cells/μl and triple the rate of active tuberculosis as seen in nonrefusers. In adjusted models, single clients [adjusted odds ratio (AOR) 1.80, 95% confidence interval (CI) 1.06-3.06] and those with active tuberculosis (AOR 3.50, 95% CI 1.55-6.61) were more likely to refuse ART.
  
  
  CONCLUSIONS
  Nearly one in five treatment-eligible HIV-infected individuals in Soweto refused to initiate ART after VCT, putting them at higher risk for early mortality. 'Feeling healthy' was given as the most common reason to refuse ART, despite a suppressed CD4(+) count and comorbidities such as tuberculosis. These findings highlight the urgent need for research to inform interventions targeting ART refusers.
authors.affiliation: Division of Women's Health and Infectious Diseases, Brigham and Women's Hospital, Boston, Massachusetts 02120, USA. ikatz2@partners.org
authors.forename: Ingrid T
authors.initials: IT
authors.lastname: Katz
authors.forename: Thandekile
authors.initials: T
authors.lastname: Essien
authors.forename: Edmore T
authors.initials: ET
authors.lastname: Marinda
authors.forename: Glenda E
authors.initials: GE
authors.lastname: Gray
authors.forename: David R
authors.initials: DR
authors.lastname: Bangsberg
authors.forename: Neil A
authors.initials: NA
authors.lastname: Martinson
authors.forename: Guy
authors.initials: G
authors.lastname: De Bruyn
mesh_terms: D000328:Adult; D019380:Anti-HIV Agents / Q000008:administration & dosage*; D003430:Cross-Sectional Studies; D005260:Female; D015658:HIV Infections / Q000188:drug therapy* / Q000453:epidemiology / Q000523:psychology; D007722:Health Knowledge, Attitudes, Practice; D006801:Humans; D016015:Logistic Models; D008297:Male; D010342:Patient Acceptance of Health Care / Q000523:psychology / Q000706:statistics & numerical data*; D013019:South Africa / Q000453:epidemiology
chemical_list: D019380:Anti-HIV Agents