title: Who starts? Factors associated with starting antiretroviral therapy among eligible patients in two, public HIV clinics in Lilongwe, Malawi.
abstract: BACKGROUND
  Lighthouse Trust operates two, public, integrated HIV clinics, Lighthouse (LH) and Martin Preuss Center (MPC), in Lilongwe, Malawi. Approximately 20% of patients eligible for antiretroviral therapy (ART) do not start ART. We explore individual and geographic factors that influence whether ART-eligible patients initiate ART.
  
  
  METHODS
  Adult patients eligible for ART between 2008-2011 were included. Analysis was stratified by clinic. Using logistic regression, we evaluated factors associated with initiating ART including gender, age, body mass index (BMI), employment, tuberculosis (TB), eligible at initial registration, WHO stage, CD4, months in pre-ART care (from initial registration to eligibility date), and patient neighborhood distance to clinic.
  
  
  RESULTS
  Of 14,216 study patients, 4841 were from LH; 9285 were from MPC. At LH and MPC, respectively, median age was 34.2 and 33.8 years; median BMI was 22.0 and 20.6; and median distance was 5.6 and 4.9 Km. In multivariate models, odds of starting ART was highest among those older than 35 years and those eligible for ART based on WHO stages 3-4 vs. those in WHO stages 1-2 with CD4<250. Patients with 1-12 months in pre-ART were at least 11 times more likely to start ART than peers with less pre-ART time. At LH, living 2.5-5 Km from the clinic increased the likelihood of starting ART over patients living closer.
  
  
  CONCLUSIONS
  Length of the pre-ART period is the most significant predictor of starting ART among eligible patients. Better understanding of motivation for retention in pre-ART care may reduce attrition along the treatment cascade.
authors.affiliation: Lighthouse Trust, Lilongwe, Malawi. cfeldacker@gmail.com
authors.forename: Caryl
authors.initials: C
authors.lastname: Feldacker
authors.forename: Derek
authors.initials: D
authors.lastname: Johnson
authors.forename: Mina
authors.initials: M
authors.lastname: Hosseinipour
authors.forename: Sam
authors.initials: S
authors.lastname: Phiri
authors.forename: Hannock
authors.initials: H
authors.lastname: Tweya
mesh_terms: D000328:Adult; D019380:Anti-HIV Agents / Q000627:therapeutic use*; D023241:Antiretroviral Therapy, Highly Active / Q000706:statistics & numerical data*; D005260:Female; D015658:HIV Infections / Q000188:drug therapy* / Q000453:epidemiology; D006268:Health Facilities / Q000706:statistics & numerical data*; D006801:Humans; D016015:Logistic Models; D008295:Malawi / Q000453:epidemiology; D008297:Male; D015999:Multivariate Analysis
chemical_list: D019380:Anti-HIV Agents