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Acceptability of Early Antiretroviral Therapy Among South African Women

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Abstract

WHO guidelines recommend immediate initiation of antiretroviral therapy (ART) for all individuals at HIV diagnosis regardless of CD4 count, but concerns remain about potential low uptake or poor adherence among healthy patients with high CD4 counts, especially in resource-limited settings. This study assessed the acceptability of earlier treatment among HIV-positive South African women, median age at enrollment 25 (IQR 22–30), in a 10 year prospective cohort study by (i) describing temporal CD4 count trends at initiation in relation to WHO guidance, (ii) virological suppression rates post-ART initiation at different CD4 count thresholds, and (iii) administration of a standardized questionnaire. 158/232 (68.1%) participants initiated ART between 2006 and 2015. Mean CD4 count at initiation was 217 cells/µl (range 135-372) before 2010, and increased to 531 cells/µl (range 272–1095) by 2015 (p < 0.001). Median viral load at ART initiation decreased over this period from 5.2 (IQR 4.6–5.6) to 4.1 (IQR 3.4–4.6) log copies/ml (p = 0.004). Virological suppression rates at 3, 6, 12 and 18 months were consistently above 85% with no statistically significant differences for participants starting ART at different CD4 count thresholds. A questionnaire assessing uptake of early ART amongst ART-naïve women, median age 28 (IQR 24–33), revealed that 40/51 (78.4%) were willing to start ART at CD4 ≥500. Of those unwilling, 6/11 (54.5%) started ART within 6 months of questionnaire administration. Temporal increases in CD4 counts, comparable virological suppression rates, and positive patient perceptions confirm high acceptability of earlier ART initiation for the majority of patients.

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Acknowledgements

We thank the CAPRISA 002 Study Team and all the CAPRISA 002 study participants who continue to make an important contribution to HIV research.

Funding

Over the past decade, the CAPRISA 002 study has received support from the National Institute of Allergy and infectious Disease (NIAID), National Institutes of Health (NIH) (Grant # AI51794), from CONRAD (USAID co-operative Grant # GP00-08-00005-00, subproject agreement # PPA-09-046), from the National Research Foundation (Grants # 67385, # 96354), the Technology Innovation Agency, and the Columbia University-Southern African Fogarty AIDS International Training and Research Programme (AITRP) funded by the Fogarty International Center, NIH (Grant # D43TW00231).

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Authors and Affiliations

  1. Centre for the AIDS Programme of Research in South Africa (CAPRISA), Doris Duke Medical Research Institute, Nelson R Mandela School of Medicine, University of KwaZulu-Natal, 2nd Floor, 719 Umbilo Road, Congella, Private Bag X7, Durban, 4013, South Africa

    Nigel Garrett, Emily Norman, Kerry Leask, Nivashnee Naicker, Villeshni Asari, Nelisile Majola, Quarraisha Abdool Karim & Salim S. Abdool Karim

  2. Department of Epidemiology, Columbia University, New York City, USA

    Emily Norman, Quarraisha Abdool Karim & Salim S. Abdool Karim

Authors
  1. Nigel Garrett
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  2. Emily Norman
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  3. Kerry Leask
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  4. Nivashnee Naicker
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  5. Villeshni Asari
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  6. Nelisile Majola
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  7. Quarraisha Abdool Karim
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  8. Salim S. Abdool Karim
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Correspondence to Nigel Garrett.

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The authors have no conflict of interest to declare.

Ethical Approval

All procedures performed in this study were approved by the Biomedical Research Ethics Committee of the University of KwaZulu-Natal and were in accordance with the 1964 Helsinki Declaration and its later amendments.

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Garrett, N., Norman, E., Leask, K. et al. Acceptability of Early Antiretroviral Therapy Among South African Women. AIDS Behav 22, 1018–1024 (2018). https://doi.org/10.1007/s10461-017-1729-2

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