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Lack of pre-antiretroviral care and competition from traditional healers, crucial risk factors for very late initiation of antiretroviral therapy for HIV: A case-control study from eastern Uganda
District Health Office, Iganga District Administration, Iganga, Uganda.
Department of Epidemiology and Biostatistics, Makerere University School of Public Health, Kampala, Uganda.
Makerere University Iganga/Mayuge Health and Demographic Surveillance System, Kampala, Uganda.
Division of Global Health, IHCAR, Department of Public Health Sciences, Karolinska Institutet, Sweden.
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2011 (English)In: The Pan African medical journal, ISSN 1937-8688, Vol. 8, no 40Article in journal (Refereed) Published
Abstract [en]


Although WHO recommends starting antiretroviral treatment at a CD4 count of 350 cells/[µ]L, many Ugandan districts still struggle with large proportions of clients initiating ART very late at CD4 < 50 cells/[µ]L. This study seeks to establish crucial risk factors for very late ART initiation in eastern Uganda.


All adult HIV-infected clients on ART in Iganga who enrolled between 2005 and 2009 were eligible for this case-control study. Clients who started ART at CD4 cell count of < 50 cells/[µ]L (very late initiators) were classified as cases and 50-200 cells/[µ]L (late initiators) as control subjects. A total of 152 cases and 202 controls were interviewed. Multivariate analyses were performed to calculate adjusted odds ratios and 95% confidence intervals.


Reported health system-related factors associated with very late ART initiation were stock-outs of antiretroviral drugs stock-outs (affecting 70% of the cases and none of the controls), competition from traditional/spiritual healers (AOR 7.8, 95 CI% 3.7-16.4), and lack of pre-ARV care (AOR 4.6, 95% CI: 2.3-9.3). Men were 60% more likely and subsistence farmers six times more likely (AOR 6.3, 95% CI: 3.1-13.0) to initiate ART very late. Lack of family support tripled the risk of initiating ART very late (AOR 3.3, 95% CI: 1.6-6.6).


Policy makers should prevent ARV stock-outs though effective ARV procurement and supply chain management. New HIV clients should seek pre-ARV care for routine monitoring and determination of ART eligibility. ART services should be more affordable, accessible and user-friendly to make them more attractive than traditional healers.

Place, publisher, year, edition, pages
2011. Vol. 8, no 40
National Category
Medical and Health Sciences
URN: urn:nbn:se:uu:diva-163270PubMedID: 22121448OAI: oai:DiVA.org:uu-163270DiVA: diva2:463453
Available from: 2011-12-09 Created: 2011-12-09 Last updated: 2012-03-13Bibliographically approved

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