title: Barriers to antiretroviral treatment initiation in rural KwaZulu-Natal, South Africa.
abstract: OBJECTIVE
  Although antiretroviral therapy (ART) has been freely available since 2004 in South Africa, not all those who are eligible initiate ART. We aimed to investigate individual and household characteristics as barriers to ART initiation in men and women in rural KwaZulu-Natal.
  
  
  METHODS
  Adults ≥ 16 years old living within a sociodemographic surveillance area (DSA) who accessed the local HIV programme between 2007 and 2011 were included in the study. Individual and household factors associated with ART initiation within 3 months of becoming eligible for ART were investigated using multivariable logistic regression stratified by sex and after exclusion of individuals who died before initiating ART.
  
  
  RESULTS
  Of the 797 men and 1598 women initially included, 8% and 5.5%, respectively, died before ART initiation and were excluded from further analysis. Of the remaining 733 men and 1510 women, 68.2% and 60.2%, respectively, initiated ART ≤ 3 months after becoming eligible (P = 0.34 after adjustment for CD4 cell count). In men, factors associated with a higher ART initiation rate were being a member of a household located < 2 km from the nearest HIV clinic and being resident in the DSA at the time of ART eligibility. In women, ART initiation was more likely in those who were not pregnant, in members of a household where at least one person was on ART and in those with a high wealth index.
  
  
  CONCLUSIONS
  In this rural South African setting, barriers to ART initiation differed for men and women. Supportive individual- and household-level interventions should be developed to guarantee rapid ART initiation taking account gender specificities.
authors: Centre INSERM U897 for Epidemiology and Biostatistics, Bordeaux, France.|ISPED, University of Bordeaux, France.
authors: M
authors: M
authors: Plazy
authors: Africa Centre for Health and Population Studies, University of KwaZulu-Natal, South Africa.|Faculty of Medicine, University of Southampton, Southampton, UK.
authors: M-L
authors: ML
authors: Newell
authors: Centre INSERM U897 for Epidemiology and Biostatistics, Bordeaux, France.|ISPED, University of Bordeaux, France.
authors: J
authors: J
authors: Orne-Gliemann
authors: Africa Centre for Health and Population Studies, University of KwaZulu-Natal, South Africa.
authors: K
authors: K
authors: Naidu
authors: Centre INSERM U897 for Epidemiology and Biostatistics, Bordeaux, France.|ISPED, University of Bordeaux, France.
authors: F
authors: F
authors: Dabis
authors: UMR_S 1136, Pierre Louis Institute of Epidemiology and Public Health, Team of Research in Social Epidemiology, INSERM, Paris, France.|UPMC Univ Paris 06, UMR_S 1136, Pierre Louis Institute of Epidemiology and Public Health, Team of Research in Social Epidemiology, Sorbonne Universités, Paris, France.
authors: R
authors: R
authors: Dray-Spira
mesh_terms: D000293:Adolescent; D000328:Adult; D044966:Anti-Retroviral Agents / Q000627:therapeutic use*; D005260:Female; D015658:HIV Infections / Q000188:drug therapy* / Q000453:epidemiology; D006297:Health Services Accessibility; D006801:Humans; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D012307:Risk Factors; D012424:Rural Population; D013019:South Africa / Q000453:epidemiology; D061665:Time-to-Treatment; D055815:Young Adult
chemical_list: D044966:Anti-Retroviral Agents
keywords: HIV; South Africa; adults; antiretroviral agents; men; rural health services; therapeutic initiation; women