title: Factors associated with late antiretroviral therapy initiation in Cameroon: a representative multilevel analysis.
abstract: OBJECTIVE
  Many people living with HIV/AIDS in resource-limited settings begin antiretroviral therapy (ART) at low CD4 counts. Here, we investigated the simultaneous effect of individual-, facility- and regional-level factors on late ART initiation.
  
  
  METHODS
  We conducted a survey in a nationally representative sample of 55 HIV treatment facilities in Cameroon. Medical records of 4935 patients >15 years of age who initiated ART in the month of October during the period 2007-10 were reviewed to gather individual characteristics. Late ART initiation was defined as CD4 count ≤ 100 cells/mm(3). Facility- and regional-level characteristics were also collected. Two-level regression logistic models were used to identify factors associated with late ART initiation.
  
  
  RESULTS
  Late ART initiation was associated with being a male younger than 45 years versus female younger than 45 years [adjusted OR (AOR) = 1.5, 95% CI: 1.3-1.7] and initiating ART in the period 2007-09 versus 2010 (AOR = 1.2, 95% CI: 1.0-1.4). Late initiation was more likely in central than in district hospitals (AOR = 1.3, 95% CI: 1.1-1.6) and in hospitals without a mother-to-child transmission programme (AOR = 1.9, 95% CI: 1.3-2.8). Living in a region with a higher comprehensive knowledge of HIV/AIDS was associated with not initiating ART late (AOR = 0.8, 95% CI: 0.6-1.0).
  
  
  CONCLUSIONS
  This study shows that risk factors associated with late ART initiation operate at multiple levels and that multilevel interventions are therefore necessary to promote earlier HIV testing and treatment.
authors: UPMC University Paris 06, UMR_S 943, INSERM, F-75005, Paris, France. jacques.ndawinz@ccde.chups.jussieu.fr
authors: Jacques D A
authors: JD
authors: Ndawinz
authors: Basile
authors: B
authors: Chaix
authors: Sinata
authors: S
authors: Koulla-Shiro
authors: Eric
authors: E
authors: Delaporte
authors: Barnabe
authors: B
authors: Okouda
authors: Ambroise
authors: A
authors: Abanda
authors: Severin
authors: S
authors: Tchomthe
authors: Etienne
authors: E
authors: Mboui
authors: Dominique
authors: D
authors: Costagliola
authors: Virginie
authors: V
authors: Supervie
mesh_terms: D000293:Adolescent; D000328:Adult; D000367:Age Factors; D019380:Anti-HIV Agents / Q000627:therapeutic use*; D023241:Antiretroviral Therapy, Highly Active / Q000706:statistics & numerical data*; D018791:CD4 Lymphocyte Count; D002163:Cameroon / Q000453:epidemiology; D005260:Female; D005843:Geography; D015658:HIV Infections / Q000188:drug therapy* / Q000453:epidemiology / Q000821:virology; D019538:Health Care Surveys; D006268:Health Facilities / Q000706:statistics & numerical data; D007722:Health Knowledge, Attitudes, Practice; D006801:Humans; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D055361:Multilevel Analysis; D015995:Prevalence; D012307:Risk Factors; D012424:Rural Population; D012737:Sex Factors; D014505:Urban Population; D000078329:Workforce; D055815:Young Adult
chemical_list: D019380:Anti-HIV Agents
keywords: HIV treatment; multivariate analysis; people living with HIV/AIDS; risk factors; sub-Saharan Africa