title: The problem of late ART initiation in Sub-Saharan Africa: a transient aspect of scale-up or a long-term phenomenon?
abstract: Efforts to scale-up HIV care and treatment have been successful at initiating large numbers of patients onto antiretroviral therapy (ART), although persistent challenges remain to optimizing scale-up effectiveness in both resource-rich and resource-limited settings. Among the most important are very high rates of ART initiation in the advanced stages of HIV disease, which in turn drive morbidity, mortality, and onward transmission of HIV. With a focus on sub-Saharan Africa, this review article presents a conceptual framework for a broader discussion of the persistent problem of late ART initiation, including a need for more focus on the upstream precursors (late HIV diagnosis and late enrollment into HIV care) and their determinants. Without additional research and identification of multilevel interventions that successfully promote earlier initiation of ART, the problem of late ART initiation will persist, significantly undermining the long-term impact of HIV care scale-up on reducing mortality and controlling the HIV epidemic.
authors: ICAP-Columbia University, Mailman School of Public Health, New York, NY 10032, USA. ml2842@columbia.edu
authors: Maria
authors: M
authors: Lahuerta
authors: Frances
authors: F
authors: Ue
authors: Susie
authors: S
authors: Hoffman
authors: Batya
authors: B
authors: Elul
authors: Sarah Gorrell
authors: SG
authors: Kulkarni
authors: Yingfeng
authors: Y
authors: Wu
authors: Harriet
authors: H
authors: Nuwagaba-Biribonwoha
authors: Robert H
authors: RH
authors: Remien
authors: Wafaa
authors: W
authors: El Sadr
authors: Denis
authors: D
authors: Nash
mesh_terms: D017954:Africa South of the Sahara; D019380:Anti-HIV Agents / Q000627:therapeutic use*; D057191:Capacity Building; D057210:Delayed Diagnosis; D015658:HIV Infections / Q000188:drug therapy*; D006297:Health Services Accessibility; D006801:Humans
chemical_list: D019380:Anti-HIV Agents
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