Factors associated with delayed and late ART initiation among people living with HIV in BC: results from the engage study.

ABSTRACT

We examined correlates of late and delayed initiation of antiretroviral therapy (ART) in British Columbia, Canada. From December 2013 to December 2015 we recruited treatment-naïve people living with HIV who initiated ART within the previous year. 'Late initiation' was defined as CD4 cell count ≤500 cells/µL at ART initiation and 'delayed initiation' as ≥1 year between HIV diagnosis and initiation. Multivariable logistic regression assessed independent correlates of late and delayed initiation. Of 87 participants, 44 (51%) initiated late and 22 (26%) delayed initiation. Delayed initiation was positively associated with older age (adjusted odds ratio [AOR] 1.06 per year, 95% confidence interval [95% CI] 1.01-1.12) and inversely associated with wanting to start ART at diagnosis (AOR 0.06, 95% CI 0.02-0.21). Variables associated with late initiation were older age (AOR 1.09 per year, 95% CI 1.03-1.15) and medical reason(s) for initiation (AOR 5.00, 95% CI 1.41-17.86). Late initiation was less likely among those with greater perceived ART efficacy (AOR 0.94, 95% CI 0.90-0.98) and history of incarceration (AOR 0.12, 95% CI 0.03-0.56). Disparities in timing of initiation were observed for age, perceived ART efficacy, and history of incarceration. Enhanced health services that address these factors may facilitate earlier treatment initiation.