title: Time to initiation of antiretroviral therapy among patients who Are ART eligible in Rwanda: improvement over time.
abstract: BACKGROUND
  Delayed initiation of antiretroviral therapy (ART) in eligible patients is a concern in resource-limited countries.
  
  
  METHODS
  We analyzed data on HIV-positive patients ≥15 years enrolled at 41 ICAP-supported health care facilities in Rwanda, 2005-2010, to determine time to ART initiation among patients eligible at enrollment compared with those ineligible or of indeterminate eligibility who become eligible during follow-up. ART eligibility was based on CD4 cell count (CD4) and WHO staging; patients lacking CD4 and WHO stage were considered indeterminate. Cumulative incidence of reaching ART eligibility and to ART initiation after eligibility was generated using competing risk estimators.
  
  
  RESULTS
  A total of 31,033 ART-naive adults were enrolled; 64.2% were female. At enrollment, 10,158 (32.7%) patients were ART eligible, 13,372 (43.1%) were ineligible for ART, and 7503 (24.2%) patients were indeterminate. Among patients retained in care pre-ART eligibility, 17.9% [95% confidence interval (CI): 17.2 to 18.6] of ineligible and 22.8% (95% CI: 21.7 to 23.8) of indeterminate patients at enrollment reached ART eligibility within 12 months. Cumulative incidence of ART initiation within 3 months for patients eligible at enrollment was 77.2% (95% CI: 76.4 to 78.0) compared with 67.9% (95% CI: 66.4 to 69.3) for ineligible and 63.8% (95% CI: 61.9 to 65.8) for patients with indeterminate eligibility at enrollment (P < 0.05). Over the study period, there was more rapid ART initiation for patients who became ART eligible.
  
  
  CONCLUSIONS
  We found higher rates of ART initiation within 3 months among patients who were ART eligible at enrollment compared with those who reached eligibility during follow-up. From 2006 to 2011, earlier initiation of ART after eligibility was observed likely reflecting improved program quality.
authors.affiliation: *ICAP-Columbia University, New York, NY; †Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, NY; and ‡Rwanda Biomedical Center, Kigali, Rwanda.
authors.forename: Chloe A
authors.initials: CA
authors.lastname: Teasdale
authors.forename: Chunhui
authors.initials: C
authors.lastname: Wang
authors.forename: Uwinkindi
authors.initials: U
authors.lastname: Francois
authors.forename: Jean dʼAmour
authors.initials: Jd
authors.lastname: Ndahimana
authors.forename: Mutabazi
authors.initials: M
authors.lastname: Vincent
authors.forename: Ruben
authors.initials: R
authors.lastname: Sahabo
authors.forename: Wafaa M
authors.initials: WM
authors.lastname: El-Sadr
authors.forename: Elaine J
authors.initials: EJ
authors.lastname: Abrams
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D044966:Anti-Retroviral Agents / Q000627:therapeutic use*; D023241:Antiretroviral Therapy, Highly Active / Q000379:methods*; D018791:CD4 Lymphocyte Count; D005260:Female; D015658:HIV Infections / Q000188:drug therapy* / Q000276:immunology / Q000473:pathology*; D006801:Humans; D008137:Longitudinal Studies; D008297:Male; D008875:Middle Aged; D012432:Rwanda; D012720:Severity of Illness Index; D013997:Time Factors; D055815:Young Adult
chemical_list: D044966:Anti-Retroviral Agents