title: Access to antiretroviral therapy and survival in eastern Europe and central Asia: a case study in Armenia.
abstract: BACKGROUND
  Antiretroviral therapy (ART) substantially improves the health of people living with HIV and contributes to preventing new infections. While HIV incidence is decreasing in most regions, the epidemic in eastern Europe continues to rise, as new infections currently outnumber the rate of ART initiation. In this study, we assess ART use in Armenia and its impact on the number of AIDS diagnoses and mortality.
  
  
  METHODS
  National surveillance data were obtained from the National Centre for AIDS Prevention, Armenia. Cox-proportional hazard models were used to determine the effect of demographic and clinical risk factors, including access to ART, on AIDS and mortality.
  
  
  RESULTS
  Among people diagnosed with HIV since 2005, approximately 40% per year were diagnosed with CD4<200 cells per mL. Overall, 232 people (57.1%) with AIDS or a low CD4 count had not received ART by the end of 2010. Mortality was 34.1% among people living with HIV who did not initiate ART, and 0.3% among people who received ART. Among people diagnosed with HIV from 1996 to 2010, age at diagnosis, no use of ART, likely mode of transmission, likely place of transmission, low baseline CD4 count and no STI diagnosis at last contact are significantly associated with death.
  
  
  CONCLUSIONS
  In Armenia, HIV is frequently diagnosed at a late stage of disease, indicating low testing rates. Of people diagnosed with HIV and in need of ART, a large proportion (approximately 60%) either do not provide consent for treatment, or are who migrants who cannot be located.
  
  
  CONCLUSIONS
  Globally, the scale-up of ART has resulted in substantial reductions in mortality among individuals initiating therapy. However, in an era of momentum for treatment as prevention, treatment levels are not at adequate levels for preventing morbidities and mortality in some settings. Particular focus should be placed on key at-risk subgroups.
authors.affiliation: The Kirby Institute, University of New South Wales, Sydney, Australia.
authors.forename: Kylie-Ann
authors.initials: KA
authors.lastname: Mallitt
authors.affiliation: National Center for AIDS Prevention, Yerevan, Armenia.
authors.forename: Samvel R
authors.initials: SR
authors.lastname: Grigoryan
authors.affiliation: National Center for AIDS Prevention, Yerevan, Armenia.
authors.forename: Arshak S
authors.initials: AS
authors.lastname: Papoyan
authors.affiliation: The Kirby Institute, University of New South Wales, Sydney, Australia.
authors.forename: Handan C
authors.initials: HC
authors.lastname: Wand
authors.affiliation: The Kirby Institute, University of New South Wales, Sydney, Australia.
authors.forename: David P
authors.initials: DP
authors.lastname: Wilson
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D044966:Anti-Retroviral Agents / Q000627:therapeutic use*; D001136:Armenia / Q000453:epidemiology; D002648:Child; D002675:Child, Preschool; D015331:Cohort Studies; D005260:Female; D015658:HIV Infections / Q000175:diagnosis / Q000188:drug therapy* / Q000453:epidemiology / Q000401:mortality*; D006297:Health Services Accessibility; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D016019:Survival Analysis; D055815:Young Adult
chemical_list: D044966:Anti-Retroviral Agents
keywords: AIDS; Europe; survival; treatment
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