title: Delay of antiretroviral therapy initiation is common in East African HIV-infected individuals in serodiscordant partnerships.
abstract: OBJECTIVE
  WHO guidance recommends antiretroviral therapy (ART) initiation for all persons with a known HIV-uninfected partner, as a strategy to prevent HIV transmission. Uptake of ART among HIV-infected partners in serodiscordant partnerships is not known, which we evaluated in African HIV serodiscordant couples.
  
  
  METHODS
  Prospective cohort study.
  
  
  METHODS
  Among HIV-infected persons from Kenya and Uganda who had a known heterosexual HIV-uninfected partner, we assessed ART initiation in those who became ART eligible under national guidelines during follow-up. Participants received quarterly clinical and semi-annual CD4 monitoring, and active referral for ART upon becoming eligible.
  
  
  RESULTS
  Of 1958 HIV-infected ART-eligible partners, 58% were women, and the median age was 34 years. At the first visit when determined to be ART eligible, the median CD4 count was 273 cells per microliter (interquartile range, 221-330), 77% had WHO stage 1 or 2 HIV disease, and 96% were receiving trimethoprim-sulfamethoxazole prophylaxis. The cumulative probabilities of initiating ART at 6, 12, and 24 months after eligibility were 49.9%, 70.0%, and 87.6%, respectively. Younger age [<25 years; adjusted hazard ratio (AHR), 1.39; P = 0.001], higher CD4 count (AHR, 1.95; P < 0.001 for >350 compared with <200 cells/µL), higher education (AHR, 1.25; P < 0.001), and lack of income (AHR, 1.15; P = 0.02) were independent predictors for delay in ART initiation.
  
  
  CONCLUSIONS
  In the context of close CD4 monitoring, ART counseling, and active linkage to HIV care, a substantial proportion of HIV-infected persons with a known HIV-uninfected partner delayed ART initiation. Strategies to motivate ART initiation are needed, particularly for younger persons with higher CD4 counts.
authors.affiliation: Departments of *Global Health, †Epidemiology, and ‡Medicine, University of Washington, Seattle, WA; §Center for Clinical Research, Kenya Medical Research Institute, Nairobi, Kenya; ‖Department of Medicine, Makerere University, Kampala, Uganda; and ¶Kabwohe Clinical Research Centre, Kabwohe, Uganda.
authors.forename: Andrew
authors.initials: A
authors.lastname: Mujugira
authors.forename: Connie
authors.initials: C
authors.lastname: Celum
authors.forename: Katherine K
authors.initials: KK
authors.lastname: Thomas
authors.forename: Carey
authors.initials: C
authors.lastname: Farquhar
authors.forename: Nelly
authors.initials: N
authors.lastname: Mugo
authors.forename: Elly
authors.initials: E
authors.lastname: Katabira
authors.forename: Elizabeth A
authors.initials: EA
authors.lastname: Bukusi
authors.forename: Elioda
authors.initials: E
authors.lastname: Tumwesigye
authors.forename: Jared M
authors.initials: JM
authors.lastname: Baeten
mesh_terms: D000328:Adult; D000351:Africa, Eastern / Q000453:epidemiology; D019380:Anti-HIV Agents / Q000008:administration & dosage* / Q000627:therapeutic use*; D018791:CD4 Lymphocyte Count; D004334:Drug Administration Schedule; D005260:Female; D015658:HIV Infections / Q000453:epidemiology / Q000517:prevention & control* / Q000635:transmission; D006801:Humans; D007630:Kenya / Q000453:epidemiology; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D012307:Risk Factors; D012747:Sexual Partners; D055815:Young Adult
chemical_list: D019380:Anti-HIV Agents