title: New indicators for delay in initiation of antiretroviral treatment: estimates for Cameroon.
abstract: OBJECTIVE
  To propose two new indicators for monitoring access to antiretroviral treatment (ART) for human immunodeficiency virus (HIV); (i) the time from HIV seroconversion to ART initiation, and (ii) the time from ART eligibility to initiation, referred to as delay in ART initiation. To estimate values of these indicators in Cameroon.
  
  
  METHODS
  We used linear regression to model the natural decline in CD4+ T-lymphocyte (CD4+ cell) numbers in HIV-infected individuals over time. The model was fitted using data from a cohort of 351 people in Côte d'Ivoire. We used the model to estimate the time from seroconversion to ART initiation and the delay in ART initiation in a representative sample of 4154 HIV-infected people who started ART in Cameroon between 2007 and 2010.
  
  
  RESULTS
  In Cameroon, the median CD4+ cell counts at ART initiation increased from 140 cells/μl (interquartile range, IQR: 66 to 210) in 2007-2009 to 163 cells/μl (IQR: 73 to 260) in 2010. The estimated average time from seroconversion to ART initiation decreased from 10.4 years (95% confidence interval, CI: 10.3 to 10.5) to 9.8 years (95% CI: 9.6 to 10.0). Delay in ART initiation increased from 3.4 years (95% CI: 3.1 to 3.7) to 5.8 years (95% CI: 5.6 to 6.2).
  
  
  CONCLUSIONS
  The estimated time to initiate ART and the delay in ART initiation indicate that progress in Cameroon is insufficient. These indicators should help monitor whether public health interventions to accelerate ART initiation are successful.
authors.affiliation: INSERM, Sorbonne Universités, UPMC Univ Paris 06, UMR_S 1136, Institut Pierre Louis d'Epidémiologie et de Santé Publique, F-75013, Paris, France .
authors.forename: Jacques D A
authors.initials: JD
authors.lastname: Ndawinz
authors.affiliation: INSERM, Université Bordeaux, Bordeaux, France .
authors.forename: Xavier
authors.initials: X
authors.lastname: Anglaret
authors.affiliation: IRD, Université de Montpellier 1, Montpellier, France .
authors.forename: Eric
authors.initials: E
authors.lastname: Delaporte
authors.affiliation: Faculty of Medicine and Biomedical Sciences, University of Yaoundé, Yaoundé, Cameroon .
authors.forename: Sinata
authors.initials: S
authors.lastname: Koulla-Shiro
authors.affiliation: INSERM, Université Bordeaux, Bordeaux, France .
authors.forename: Delphine
authors.initials: D
authors.lastname: Gabillard
authors.affiliation: Programme PACCI, Abidjan, Côte d'Ivoire .
authors.forename: Albert
authors.initials: A
authors.lastname: Minga
authors.affiliation: INSERM, Sorbonne Universités, UPMC Univ Paris 06, UMR_S 1136, Institut Pierre Louis d'Epidémiologie et de Santé Publique, F-75013, Paris, France .
authors.forename: Dominique
authors.initials: D
authors.lastname: Costagliola
authors.affiliation: INSERM, Sorbonne Universités, UPMC Univ Paris 06, UMR_S 1136, Institut Pierre Louis d'Epidémiologie et de Santé Publique, F-75013, Paris, France .
authors.forename: Virginie
authors.initials: V
authors.lastname: Supervie
mesh_terms: D000293:Adolescent; D000328:Adult; D044966:Anti-Retroviral Agents / Q000494:pharmacology*; D018791:CD4 Lymphocyte Count; D002163:Cameroon; D015331:Cohort Studies; D007560:Cote d'Ivoire; D004608:Eligibility Determination; D005260:Female; D006679:HIV Seropositivity / Q000097:blood / Q000188:drug therapy*; D006297:Health Services Accessibility; D006801:Humans; D016014:Linear Models; D008297:Male; D008875:Middle Aged; D013997:Time Factors; D055815:Young Adult
chemical_list: D044966:Anti-Retroviral Agents