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Lubega Muhamadi, Tumwesigye Nazarius Mbona, Daniel Kadobera, Marrone Gaetano, Fred Wabwire-Mangen, Pariyo George, Peterson Stefan, Ekström Anna Mia. 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. The Pan African Medical Journal. 2011;8:40 Key words: Pre-antiretroviral care, competition from traditional healers, Very late ART initiation Permanent link: http://www.panafrican-med-journal.com/content/article/8/40/full Received: 11/02/2011 - Accepted: 03/04/2011 - Published: 07/04/2011 © Lubega Muhamadi et al. The Pan African Medical Journal - ISSN 1937-8688. This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/2.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. |
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
Lubega Muhamadi1,3,4,5,7,&, Tumwesigye Nazarius Mbona2, Daniel Kadobera3, Marrone Gaetano4, Fred Wabwire-Mangen2, Pariyo George5, Peterson Stefan4,6, Ekström Anna Mia4,8
1District Health Office, Iganga District Administration, PO Box 358, Iganga, Uganda, 2Department of Epidemiology and Biostatistics, Makerere University School of Public Health, PO Box 7072, Kampala, Uganda, 3Makerere University Iganga/Mayuge Health and Demographic Surveillance System PO BOX 7072 Kampala, Uganda, 4Division of Global Health, IHCAR, Department of Public Health Sciences Karolinska Institutet, Sweden, 5Department of Health Policy Planning and Management, Makerere University School of Public Health, PO Box 7072, Kampala, Uganda, 6IMCH, Department of Women’s and Children’s Health, Uppsala University, Sweden, 7Institute of Health Sciences Busoga University, PO Box 154, Iganga, Uganda, 8Department of Infectious Diseases, Karolinska University Hospital, Sweden
&Corresponding author
Lubega Muhamadi, District Health Office, Iganga District Administration, PO Box 358, Iganga, Uganda
Although WHO recommends starting antiretroviral treatment at a CD4 count of 350 cells/µL, many Ugandan districts still struggle with large proportions of clients initiating ART very late at CD4 <50 cells/µL. 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/µL (very late initiators) were classified as cases and 50-200 cells/µL (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
