title: Acceptability of Early Antiretroviral Therapy Among South African Women.
abstract: WHO guidelines recommend immediate initiation of antiretroviral therapy (ART) for all individuals at HIV diagnosis regardless of CD4 count, but concerns remain about potential low uptake or poor adherence among healthy patients with high CD4 counts, especially in resource-limited settings. This study assessed the acceptability of earlier treatment among HIV-positive South African women, median age at enrollment 25 (IQR 22-30), in a 10 year prospective cohort study by (i) describing temporal CD4 count trends at initiation in relation to WHO guidance, (ii) virological suppression rates post-ART initiation at different CD4 count thresholds, and (iii) administration of a standardized questionnaire. 158/232 (68.1%) participants initiated ART between 2006 and 2015. Mean CD4 count at initiation was 217 cells/µl (range 135-372) before 2010, and increased to 531 cells/µl (range 272-1095) by 2015 (p < 0.001). Median viral load at ART initiation decreased over this period from 5.2 (IQR 4.6-5.6) to 4.1 (IQR 3.4-4.6) log copies/ml (p = 0.004). Virological suppression rates at 3, 6, 12 and 18 months were consistently above 85% with no statistically significant differences for participants starting ART at different CD4 count thresholds. A questionnaire assessing uptake of early ART amongst ART-naïve women, median age 28 (IQR 24-33), revealed that 40/51 (78.4%) were willing to start ART at CD4 ≥500. Of those unwilling, 6/11 (54.5%) started ART within 6 months of questionnaire administration. Temporal increases in CD4 counts, comparable virological suppression rates, and positive patient perceptions confirm high acceptability of earlier ART initiation for the majority of patients.
authors.affiliation: Centre for the AIDS Programme of Research in South Africa (CAPRISA), Doris Duke Medical Research Institute, Nelson R Mandela School of Medicine, University of KwaZulu-Natal, 2nd Floor, 719 Umbilo Road, Congella, Private Bag X7, Durban, 4013, South Africa. nigel.garrett@caprisa.org.
authors.forename: Nigel
authors.identifier: 0000-0002-4530-234X
authors.initials: N
authors.lastname: Garrett
authors.affiliation: Centre for the AIDS Programme of Research in South Africa (CAPRISA), Doris Duke Medical Research Institute, Nelson R Mandela School of Medicine, University of KwaZulu-Natal, 2nd Floor, 719 Umbilo Road, Congella, Private Bag X7, Durban, 4013, South Africa.|Department of Epidemiology, Columbia University, New York City, USA.
authors.forename: Emily
authors.initials: E
authors.lastname: Norman
authors.affiliation: Centre for the AIDS Programme of Research in South Africa (CAPRISA), Doris Duke Medical Research Institute, Nelson R Mandela School of Medicine, University of KwaZulu-Natal, 2nd Floor, 719 Umbilo Road, Congella, Private Bag X7, Durban, 4013, South Africa.
authors.forename: Kerry
authors.initials: K
authors.lastname: Leask
authors.affiliation: Centre for the AIDS Programme of Research in South Africa (CAPRISA), Doris Duke Medical Research Institute, Nelson R Mandela School of Medicine, University of KwaZulu-Natal, 2nd Floor, 719 Umbilo Road, Congella, Private Bag X7, Durban, 4013, South Africa.
authors.forename: Nivashnee
authors.initials: N
authors.lastname: Naicker
authors.affiliation: Centre for the AIDS Programme of Research in South Africa (CAPRISA), Doris Duke Medical Research Institute, Nelson R Mandela School of Medicine, University of KwaZulu-Natal, 2nd Floor, 719 Umbilo Road, Congella, Private Bag X7, Durban, 4013, South Africa.
authors.forename: Villeshni
authors.initials: V
authors.lastname: Asari
authors.affiliation: Centre for the AIDS Programme of Research in South Africa (CAPRISA), Doris Duke Medical Research Institute, Nelson R Mandela School of Medicine, University of KwaZulu-Natal, 2nd Floor, 719 Umbilo Road, Congella, Private Bag X7, Durban, 4013, South Africa.
authors.forename: Nelisile
authors.initials: N
authors.lastname: Majola
authors.affiliation: Centre for the AIDS Programme of Research in South Africa (CAPRISA), Doris Duke Medical Research Institute, Nelson R Mandela School of Medicine, University of KwaZulu-Natal, 2nd Floor, 719 Umbilo Road, Congella, Private Bag X7, Durban, 4013, South Africa.|Department of Epidemiology, Columbia University, New York City, USA.
authors.forename: Quarraisha Abdool
authors.initials: QA
authors.lastname: Karim
authors.affiliation: Centre for the AIDS Programme of Research in South Africa (CAPRISA), Doris Duke Medical Research Institute, Nelson R Mandela School of Medicine, University of KwaZulu-Natal, 2nd Floor, 719 Umbilo Road, Congella, Private Bag X7, Durban, 4013, South Africa.|Department of Epidemiology, Columbia University, New York City, USA.
authors.forename: Salim S Abdool
authors.initials: SSA
authors.lastname: Karim
mesh_terms: D000328:Adult; D023241:Antiretroviral Therapy, Highly Active / Q000379:methods*; D044383:Black People / Q000523:psychology* / Q000706:statistics & numerical data; D018791:CD4 Lymphocyte Count; D015331:Cohort Studies; D005260:Female; D015658:HIV Infections / Q000188:drug therapy* / Q000453:epidemiology / Q000821:virology; D006801:Humans; D059408:Pain Management; D010342:Patient Acceptance of Health Care / Q000208:ethnology / Q000523:psychology*; D011446:Prospective Studies; D055502:Secondary Prevention; D013019:South Africa / Q000453:epidemiology; D011795:Surveys and Questionnaires; D019562:Viral Load / Q000187:drug effects*; D055815:Young Adult
keywords: Antiretroviral therapy; CD4 count; HIV; South African women