Ingrid V. Bassett|Susan Regan|Senica Chetty|Janet Giddy|Lauren M. Uhler|Helga Holst|Douglas S. Ross|Jeffrey N. Katz|Rochelle P. Walensky|Kenneth A. Freedberg|Elena Losina
Who starts antiretroviral therapy in Durban, South Africa?… not everyone who should
Office of Infectious Diseases|Massachusetts General Hospital|Massachusetts General Hospital|McCord Hospital|McCord Hospital|Massachusetts General Hospital|McCord Hospital|St. Mary’s Hospital|Brigham and Women's Hospital|Office of Infectious Diseases|Massachusetts General Hospital|International Epidemiology Institute|Office of Infectious Diseases|Brigham and Women's Hospital|Massachusetts General Hospital|Brigham and Women's Hospital|Massachusetts General Hospital|Boston University
objective evaluate rates antiretroviral therapy art initiation within 12 months new hiv diagnosis durban south africa design prospective observational cohort methods adults 18 years enrolled hiv testing two outpatient clinics south african test identify link cohort sites offer comprehensive hiv care hiv test results cd4 cell counts dates art initiation dates death collected medical records 12month patientfamily interviews conducted art eligibility defined cd4 cell count less 200 cellsl within 90 days hiv diagnosis primary endpoint art initiation within 12 months arteligible subjects results november 2006 october 2008 1474 newly diagnosed hivinfected outpatients enrolled 1012 69 underwent cd4 cell count testing within 90 days median cd4 cell count 159 cellsl interquartile range 65299 underwent cd4 cell count testing 538 53 arteligible 210 39 eligible enrollees known initiated art within 12 months among arteligible subjects 108 known deaths 82 occurred art initiation unknown art initiation status men rate ratio rr 13 95 confidence interval ci 1115 subjects without hivinfected family memberfriend rr 13 95 ci 1117 likely start art conclusion less half arteligible subjects started art within 12 months substantial attrition mortality follow hiv diagnosis art initiation durban south africa major efforts directed towards earlier hiv diagnosis effective linkage care timely art initiation urgently needed