%0 Journal Article
%T Reasons for delayed antiretroviral therapy (ART) initiation in the era of early ART initiation guidelines: a retrospective service evaluation
%A Angela C Bailey
%A Esra Musbahi
%A Jhia Teh
%A Julie Fox
%A Katia EH Florman
%A Ming J Lee
%A Nicola E Mackie
%A Ojali Negedu
%A Sarah Fidler
%A Serena Venturelli
%A Wayne McKenna
%J International Journal of STD & AIDS
%@ 1758-1052
%D 2019
%R 10.1177/0956462418814985
%X Following changes in national antiretroviral therapy (ART) guidelines removing the CD4 threshold for initiation of ART, we evaluated the time to ART initiation and reasons for delayed or non-initiation. A retrospective notes review of 292 newly diagnosed HIV-positive individuals attending two London clinics between August 2015 and December 2016 was performed. Two hundred and fifty-four of 292 (87%) individuals started ART. Median time to ART initiation was 29 days (range: 0¨C514). Thirty of 292 (13%) did not start ART. Rates of virological suppression at six months were similar regardless of time to ART initiation. People who inject drugs (16.7% vs. 3.6%) (p£¿=£¿0.009), having a higher median baseline CD4 cell count (500 vs. 388 cells/mm3, p£¿=£¿0.001), and having gastrointestinal/liver co-morbidities (23% vs. 9%, p£¿=£¿0.001) were associated with delayed ART initiation. The cohort not on ART had a higher median baseline CD4 cell count (500 vs. 388 cells/mm3, p£¿<£¿0.001). Documented reasons for delayed or ART non-initiation included patient¡¯s choice, prolonged adjustment periods, and difficulty leaving work. We conclude that delayed or non-initiation of ART was associated with injecting drug use and prolonged adjustment to a new HIV diagnosis. Clinician factors may include lack of urgency with higher baseline CD4 cell counts. Improved linkage to care and drug services pathways may encourage timely ART initiation
%K Antiretroviral agents
%K HIV infections
%K diagnosis
%K time-to-treatment
%K medication adherence
%U https://journals.sagepub.com/doi/full/10.1177/0956462418814985