Page 303 - HIVMED_v21_i1.indb

Page 3 of 6 Original Research

for age, sex, CD4 count and facility. Data were analysed 8 days; IQR: 0, 15). A similar proportion of men and
using STATA© v.14 (StataCorp, LLC, Texas). women initiated ART (83% and 88%, respectively; p = 0.06).
Of the 10 patients testing positive for TB, seven were
Ethical consideration initiated on ART within 30 days with the remaining three
initiated on ART within 90 days.
The study was approved by the University of the
Witwatersrand Human Research Ethics Committee, the Johns Antiretroviral therapy was initiated on the same day as
Hopkins University School of Medicine Institutional Review
Board and the Ekurhuleni District Research Committee. HIV testing for 221 patients (31.1%). The proportion of
patients initiated on ART who had SDI varied considerably
Results by facility, ranging from 8.1% to 61% (10% – 69%
for women and 0% – 45% for men). A significantly
A total of 993 patient records were identified and abstracted higher proportion of women, compared with men,
during the study period. Of these, 826 (83.2%) patients were initiated ART on the same day (36% vs. 10.4%, p < 0.001)
included in the analysis and 167 (16.8%) were excluded. (Table 2). Same-day initiation of ART was also more
Reasons for exclusion included: 111 (66.5%) had ART common among those aged < 29 years (102, 33.7%),
recorded prior to testing date, 49 (29.3%) were documented compared with those aged 30–40 years (89, 26.6%), and
to have transferred out of the healthcare facility and 7 (4.2%) those older than 40 years (30, 16%; p = 0.009). Lastly, a
were documented to have died. Of those included, greater proportion of patients with a higher CD4 count
528 (63.9%) were women, and the median age was 32 years initiated on the same-day: 42 (30%) of those with a CD4
(interquartile range [IQR]; 27, 39). Of the 10 study clinics, count > 500 cells/mm compared with 60 (21.6%) among
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the number of patients included in the analysis ranged those with a CD4 count between 200 and 500 cells/mm
3
from 65 to 99 per clinic.
and 23 (12%) of those with CD4 count < 200 cells/mm
3
Patient characteristics at human (p < 0.001; Table 3). Notably, the CD4 count results
immunodeficiency virus testing were not available to clinicians on the day of HIV testing,
so decisions around SDI were not influenced by the
The majority of patients had CD4 count documentation (610, CD4 count.
73.8%; Table 1) with a median CD4 count of 312 cells/mm
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(IQR; 156, 490). Of those with CD4 count documentation, TABLE 1: Study population characteristics for 826 patients.
nearly a third had a CD4 count of ≤ 200 cells/mm (192, 31.5%) Characteristic N %
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(Table 1). Serum creatinine was documented for less than half Sites (n) 10 -
of the patients (414, 50.1%), of which 14 (3.4%) had an Age (years) - -
estimated glomerular filtration rate of < 50 ml/min/m . < 29 303 36.7
2
335
40.5
30–39
Tuberculosis testing (GeneXpert MTB/Rif) was documented ≥ 40 188 22.8
for 45 (5.4%) patients, of which 10 tested positive for TB. Sex
Male 298 36.1
Timing of antiretroviral therapy initiation Female 528 63.9
CD4 count
Of the 826 patients included in the analysis, ART initiation < 200 192 23.2
within a year of HIV testing was documented for 710 (85.9%; 201–500 278 33.7
Table 1). Of these, the majority, 654 (92.1%), of patients ≥ 501 140 16.9
initiated ART within 30 days after HIV testing (median of Missing 216 26.2

TABLE 2: Timing of antiretroviral therapy initiation.
Characteristic Same-day 1–7 days 8–30 days 31–90 days > 90 days No ART p-value
(n = 221) (n = 105) (n = 328) (n = 51) (n = 5) (n = 116) (χ ) 2
n % n % n % n % n % n %
Age (years)
< 29 102 33.7 31 10.2 106 35.0 20 6.6 1 0.3 43 14.2 0.009
30–39 89 26.6 46 13.7 134 40.0 16 4.8 2 0.6 48 14.3
≥ 40 30 16.0 28 14.9 88 46.8 15 8.0 2 1.1 25 13.3
Sex
Male 31 10.4 49 16.4 141 47.3 24 8.1 2 0.7 51 17.1 < 0.001
Female 190 36.0 56 10.6 187 35.4 27 5.1 3 0.6 65 12.3
CD4 count
< 200 23 12.0 34 17.7 105 54.7 19 9.9 1 0.5 10 5.2 < 0.001
201–500 60 21.6 44 15.8 131 47.1 23 8.3 2 0.7 18 6.5
> 501 42 30.0 19 13.6 63 45.0 6 4.3 2 1.4 8 5.7
Missing 96 44.4 8 3.7 29 13.4 3 1.4 0 0.0 80 37.0
ART, antiretroviral therapy.

http://www.sajhivmed.org.za 295 Open Access