title: Delays in antiretroviral therapy initiation among HIV-positive individuals: results of the positive living with HIV study.
abstract: BACKGROUND
  Lack of early initiation of antiretroviral therapy (ART) remains a major health concern due to increased risk of premature mortality and further HIV transmission. This study explored CD4+ cell count monitoring in relation to delays in ART initiation among HIV-positive individuals in the Kathmandu Valley, Nepal, where ART coverage was only 23.7% in 2011.
  
  
  METHODS
  We recruited a total of 87 ART-naïve, HIV-positive individuals aged 18 to 60 years through the networks of five non-government organizations working with HIV-positive individuals. We collected data on the history of ART initiation, CD4+ cell count monitoring, socio-demographic variables, perceived family support (measured with 10-item Nepali Family Support and Difficulty Scale), depression, and HIV symptom burden. Correlates of ART eligibility were examined using multivariable logistic regression analysis.
  
  
  RESULTS
  A total of 72 of the 87 ART-naïve participants (82.8%) had monitored their CD4+ cell count in the past 6 months. Of these, 36 (50%) participants were eligible for ART initiation with CD4+ cell count <350 cells/mm(3). A total of 12 participants had CD4+ cell count <200 cells/mm(3). Lower level of perceived family support was associated with 6.05-fold higher odds (95% confidence interval =1.95 to 18.73) of being ART eligible with a CD4+ cell count <350 cells/mm(3).
  
  
  CONCLUSIONS
  High rate of delays in ART initiation and the strong association of low perceived family support with ART eligibility in our study participants suggest that HIV service providers should consider the role and impact of family support in influencing individual decisions to initiate ART among eligible HIV-positive individuals.
authors.affiliation: Department of Health Promotion and Policy, School of Public Health and Health Sciences, University of Massachusetts Amherst, Amherst, MA, USA; krishna@schoolph.umass.edu.
authors.forename: Krishna C
authors.initials: KC
authors.lastname: Poudel
authors.affiliation: Department of Health Promotion and Policy, School of Public Health and Health Sciences, University of Massachusetts Amherst, Amherst, MA, USA.
authors.forename: David R
authors.initials: DR
authors.lastname: Buchanan
authors.affiliation: College of Nursing, University of Massachusetts Amherst, Amherst, MA, USA.
authors.forename: Kalpana
authors.initials: K
authors.lastname: Poudel-Tandukar
keywords: CD4+ cell count; HIV/AIDS; Nepal; antiretroviral therapy; family support