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The journey to antiretroviral therapy in Karnataka, India: who was lost on the road?

Shastri S, Sathyanarayna S, Nagaraja SB, Kumar AM, Rewari B, Harries AD, Zachariah R - J Int AIDS Soc (2013)

Bottom Line: For ART-eligible individuals who did not initiate ART, the most common known reasons for non-initiation included dying before initiation of ART and not being willing to start ART.In a large state of India, eight in ten HIV-positive persons reached ART centres, and of those found ART eligible, 82% start treatment.Although this is an encouraging achievement, the programme needs to take further steps to improve the current performance by further reducing pre-ART attrition.

View Article: PubMed Central - PubMed

Affiliation: Karnataka State AIDS Prevention Society, Bangalore, India. susha007@gmail.com

ABSTRACT

Introduction: One important operational challenge facing antiretroviral treatment (ART) programmes in low- and middle-income countries is the loss to follow-up between diagnosis of human immunodeficiency virus (HIV) and initiation of ART. This is a major obstacle to achieving universal access to ART. This study from Karnataka, India, tried to measure such losses by determining the number of HIV-positive individuals diagnosed, the number of them reaching ART centres, the number initiated on ART and the reasons for non-initiation of ART.

Methods: A review of records routinely maintained under the National AIDS Control Programme (NACP) was carried out in six districts of Karnataka. HIV-positive persons diagnosed during the months from January to June 2011 in 233 public HIV-testing sites were followed up until December 2011 based on the pre-ART registers. A chi-square test was used to assess statistical significance.

Results: Of 2291 HIV-positive persons diagnosed (52% male; mean age of 35 years), 1829 (80%) reached ART centres. Of the latter, 1166 (64%) were eligible for ART, and 959 (82%) were initiated on treatment. Overall losses (attrition) on the road between HIV diagnosis and ART initiation were 669 (29%). Deaths, migration and not willing to go to the ART centres were cited as the main known reasons for not reaching ART centres. For ART-eligible individuals who did not initiate ART, the most common known reasons for non-initiation included dying before initiation of ART and not being willing to start ART.

Conclusions: In a large state of India, eight in ten HIV-positive persons reached ART centres, and of those found ART eligible, 82% start treatment. Although this is an encouraging achievement, the programme needs to take further steps to improve the current performance by further reducing pre-ART attrition. We recommend online registering of diagnosed HIV-positive patients to track the patients more efficiently.

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Pathway to antiretroviral treatment for HIV-positive individuals diagnosed in Karnataka, India between January and June 2011.
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Figure 0002: Pathway to antiretroviral treatment for HIV-positive individuals diagnosed in Karnataka, India between January and June 2011.

Mentions: Of those who did manage to reach ART centres, 1166 (64%) were eligible for ART, of whom 959 (82%) were initiated on treatment. Median time delay between being found ART eligible and initiating treatment was 9 days (range: 2–325 days) (Figure 2). The characteristics of ART-eligible individuals not initiated on ART are given in Table 2. Compared to other sub-groups, higher proportions of persons in the age group of 55 years and above were not initiated on ART. The median (interquartile range) CD4 count among those eligible for ART was 145 (81–245)/mm3 and did not vary significantly among those who were initiated on ART (147, 81–238) and those who were not initiated on ART (141, 78–279) (p=0.8).


The journey to antiretroviral therapy in Karnataka, India: who was lost on the road?

Shastri S, Sathyanarayna S, Nagaraja SB, Kumar AM, Rewari B, Harries AD, Zachariah R - J Int AIDS Soc (2013)

Pathway to antiretroviral treatment for HIV-positive individuals diagnosed in Karnataka, India between January and June 2011.
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC3756231&req=5

Figure 0002: Pathway to antiretroviral treatment for HIV-positive individuals diagnosed in Karnataka, India between January and June 2011.
Mentions: Of those who did manage to reach ART centres, 1166 (64%) were eligible for ART, of whom 959 (82%) were initiated on treatment. Median time delay between being found ART eligible and initiating treatment was 9 days (range: 2–325 days) (Figure 2). The characteristics of ART-eligible individuals not initiated on ART are given in Table 2. Compared to other sub-groups, higher proportions of persons in the age group of 55 years and above were not initiated on ART. The median (interquartile range) CD4 count among those eligible for ART was 145 (81–245)/mm3 and did not vary significantly among those who were initiated on ART (147, 81–238) and those who were not initiated on ART (141, 78–279) (p=0.8).

Bottom Line: For ART-eligible individuals who did not initiate ART, the most common known reasons for non-initiation included dying before initiation of ART and not being willing to start ART.In a large state of India, eight in ten HIV-positive persons reached ART centres, and of those found ART eligible, 82% start treatment.Although this is an encouraging achievement, the programme needs to take further steps to improve the current performance by further reducing pre-ART attrition.

View Article: PubMed Central - PubMed

Affiliation: Karnataka State AIDS Prevention Society, Bangalore, India. susha007@gmail.com

ABSTRACT

Introduction: One important operational challenge facing antiretroviral treatment (ART) programmes in low- and middle-income countries is the loss to follow-up between diagnosis of human immunodeficiency virus (HIV) and initiation of ART. This is a major obstacle to achieving universal access to ART. This study from Karnataka, India, tried to measure such losses by determining the number of HIV-positive individuals diagnosed, the number of them reaching ART centres, the number initiated on ART and the reasons for non-initiation of ART.

Methods: A review of records routinely maintained under the National AIDS Control Programme (NACP) was carried out in six districts of Karnataka. HIV-positive persons diagnosed during the months from January to June 2011 in 233 public HIV-testing sites were followed up until December 2011 based on the pre-ART registers. A chi-square test was used to assess statistical significance.

Results: Of 2291 HIV-positive persons diagnosed (52% male; mean age of 35 years), 1829 (80%) reached ART centres. Of the latter, 1166 (64%) were eligible for ART, and 959 (82%) were initiated on treatment. Overall losses (attrition) on the road between HIV diagnosis and ART initiation were 669 (29%). Deaths, migration and not willing to go to the ART centres were cited as the main known reasons for not reaching ART centres. For ART-eligible individuals who did not initiate ART, the most common known reasons for non-initiation included dying before initiation of ART and not being willing to start ART.

Conclusions: In a large state of India, eight in ten HIV-positive persons reached ART centres, and of those found ART eligible, 82% start treatment. Although this is an encouraging achievement, the programme needs to take further steps to improve the current performance by further reducing pre-ART attrition. We recommend online registering of diagnosed HIV-positive patients to track the patients more efficiently.

Show MeSH
Related in: MedlinePlus