title: Antiretroviral therapy uptake and coverage in four HIV community cohort studies in sub-Saharan Africa.
abstract: OBJECTIVE
  To compare socio-demographic patterns in access to antiretroviral therapy (ART) across four community HIV cohort studies in Africa.
  
  
  METHODS
  Data on voluntary counselling and testing and ART use among HIV-infected persons were analysed from Karonga (Malawi), Kisesa (Tanzania), Masaka (Uganda) and Manicaland (Zimbabwe), where free ART provision started between 2004 and 2007. ART coverage was compared across sites by calculating the proportion on ART among those estimated to need treatment, by age, sex and educational attainment. Logistic regression was used to identify socio-demographic characteristics associated with undergoing eligibility screening at an ART clinic within 2 years of being diagnosed with HIV, for three sites with information on diagnosis and screening dates.
  
  
  RESULTS
  Among adults known to be HIV-infected from serological surveys, the proportion who knew their HIV status was 93% in Karonga, 37% in Kisesa, 46% in Masaka and 25% in Manicaland. Estimated ART coverage was highest in Masaka (68%) and lowest in Kisesa (2%). The proportion of HIV-diagnosed persons who were screened for ART eligibility within 2 years of diagnosis ranged from 14% in Kisesa to 84% in Masaka, with the probability of screening uptake increasing with age at diagnosis in all sites.
  
  
  CONCLUSIONS
  Higher HIV testing rates among HIV-infected persons in the community do not necessarily correspond with higher uptake of ART, nor more equitable treatment coverage among those in need of treatment. In all sites, young adults tend to be disadvantaged in terms of accessing and initiating ART, even after accounting for their less urgent need.
authors.affiliation: London School of Hygiene and Tropical Medicine, London, UK. Alison.wringe@lshtm.ac.uk
authors.forename: Alison
authors.initials: A
authors.lastname: Wringe
authors.forename: Sian
authors.initials: S
authors.lastname: Floyd
authors.forename: Patrick
authors.initials: P
authors.lastname: Kazooba
authors.forename: Phyllis
authors.initials: P
authors.lastname: Mushati
authors.forename: Kathy
authors.initials: K
authors.lastname: Baisley
authors.forename: Mark
authors.initials: M
authors.lastname: Urassa
authors.forename: Anna
authors.initials: A
authors.lastname: Molesworth
authors.forename: Christina
authors.initials: C
authors.lastname: Schumacher
authors.forename: Jim
authors.initials: J
authors.lastname: Todd
authors.forename: Basia
authors.initials: B
authors.lastname: Zaba
mesh_terms: D000293:Adolescent; D000328:Adult; D017954:Africa South of the Sahara; D000367:Age Factors; D044966:Anti-Retroviral Agents / Q000627:therapeutic use*; D018791:CD4 Lymphocyte Count; D015331:Cohort Studies; D055812:Community-Based Participatory Research; D003376:Counseling / Q000706:statistics & numerical data; D004363:Drug Utilization; D005260:Female; D015658:HIV Infections / Q000188:drug therapy* / Q000453:epidemiology* / Q000401:mortality; D006801:Humans; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D012737:Sex Factors; D012959:Socioeconomic Factors; D016019:Survival Analysis; D055815:Young Adult; D016903:Drug Monitoring
chemical_list: D044966:Anti-Retroviral Agents