Antiretroviral therapy refusal among newly diagnosed HIV-infected adults

Ingrid T. Katz, Thandekile Essien, Edmore T. Marinda, Glenda E. Gray, David Bangsberg, Neil A. Martinson, Guy De Bruyn

Research output: Contribution to journalArticle

70 Citations (Scopus)

Abstract

OBJECTIVE:: To determine rates and predictors of treatment refusal in newly identified HIV-infected individuals in Soweto, South Africa. DESIGN:: It is designed as a cross-sectional study. METHODS:: We analyzed data from adult clients (>18 years) presenting for voluntary counseling and testing (VCT) at the Zazi Testing Center, Perinatal HIV Research Unit to determine rates of antiretroviral therapy (ART) refusal among treatment-eligible, HIV-infected individuals (CD4 cell count < 200 cells/μl or WHO stage 4). Multiple logistic regression models were used to investigate factors associated with refusal. RESULTS:: From December 2008 to December 2009, 7287 adult clients were HIV tested after counseling. Two thousand, five hundred and sixty-two (35%) were HIV-infected, of whom 743 (29%) were eligible for immediate ART. One hundred and forty-eight (20%) refused referral to initiate ART, most of whom (92%) continued to refuse after 2 months of counseling. The leading reason for ART refusal was given as 'feeling healthy' (37%), despite clients having a median CD4 cell count of 110 cells/μl and triple the rate of active tuberculosis as seen in nonrefusers. In adjusted models, single clients [adjusted odds ratio (AOR) 1.80, 95% confidence interval (CI) 1.06-3.06] and those with active tuberculosis (AOR 3.50, 95% CI 1.55-6.61) were more likely to refuse ART. CONCLUSION:: Nearly one in five treatment-eligible HIV-infected individuals in Soweto refused to initiate ART after VCT, putting them at higher risk for early mortality. 'Feeling healthy' was given as the most common reason to refuse ART, despite a suppressed CD4 count and comorbidities such as tuberculosis. These findings highlight the urgent need for research to inform interventions targeting ART refusers.

Original languageEnglish (US)
Pages (from-to)2177-2181
Number of pages5
JournalAIDS
Volume25
Issue number17
DOIs
StatePublished - Nov 13 2011
Externally publishedYes

Fingerprint

HIV
Counseling
CD4 Lymphocyte Count
Treatment Refusal
Tuberculosis
Therapeutics
Emotions
Logistic Models
Odds Ratio
Confidence Intervals
South Africa
Research
Comorbidity
Referral and Consultation
Cross-Sectional Studies
Mortality

Keywords

  • Africa
  • HIV
  • Refusal
  • Treatment
  • Voluntary counseling and testing

ASJC Scopus subject areas

  • Immunology and Allergy
  • Immunology
  • Infectious Diseases

Cite this

Katz, I. T., Essien, T., Marinda, E. T., Gray, G. E., Bangsberg, D., Martinson, N. A., & De Bruyn, G. (2011). Antiretroviral therapy refusal among newly diagnosed HIV-infected adults. AIDS, 25(17), 2177-2181. https://doi.org/10.1097/QAD.0b013e32834b6464

Antiretroviral therapy refusal among newly diagnosed HIV-infected adults. / Katz, Ingrid T.; Essien, Thandekile; Marinda, Edmore T.; Gray, Glenda E.; Bangsberg, David; Martinson, Neil A.; De Bruyn, Guy.

In: AIDS, Vol. 25, No. 17, 13.11.2011, p. 2177-2181.

Research output: Contribution to journalArticle

Katz, IT, Essien, T, Marinda, ET, Gray, GE, Bangsberg, D, Martinson, NA & De Bruyn, G 2011, 'Antiretroviral therapy refusal among newly diagnosed HIV-infected adults', AIDS, vol. 25, no. 17, pp. 2177-2181. https://doi.org/10.1097/QAD.0b013e32834b6464
Katz IT, Essien T, Marinda ET, Gray GE, Bangsberg D, Martinson NA et al. Antiretroviral therapy refusal among newly diagnosed HIV-infected adults. AIDS. 2011 Nov 13;25(17):2177-2181. https://doi.org/10.1097/QAD.0b013e32834b6464
Katz, Ingrid T. ; Essien, Thandekile ; Marinda, Edmore T. ; Gray, Glenda E. ; Bangsberg, David ; Martinson, Neil A. ; De Bruyn, Guy. / Antiretroviral therapy refusal among newly diagnosed HIV-infected adults. In: AIDS. 2011 ; Vol. 25, No. 17. pp. 2177-2181.
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abstract = "OBJECTIVE:: To determine rates and predictors of treatment refusal in newly identified HIV-infected individuals in Soweto, South Africa. DESIGN:: It is designed as a cross-sectional study. METHODS:: We analyzed data from adult clients (>18 years) presenting for voluntary counseling and testing (VCT) at the Zazi Testing Center, Perinatal HIV Research Unit to determine rates of antiretroviral therapy (ART) refusal among treatment-eligible, HIV-infected individuals (CD4 cell count < 200 cells/μl or WHO stage 4). Multiple logistic regression models were used to investigate factors associated with refusal. RESULTS:: From December 2008 to December 2009, 7287 adult clients were HIV tested after counseling. Two thousand, five hundred and sixty-two (35{\%}) were HIV-infected, of whom 743 (29{\%}) were eligible for immediate ART. One hundred and forty-eight (20{\%}) refused referral to initiate ART, most of whom (92{\%}) continued to refuse after 2 months of counseling. The leading reason for ART refusal was given as 'feeling healthy' (37{\%}), despite clients having a median CD4 cell count of 110 cells/μl and triple the rate of active tuberculosis as seen in nonrefusers. In adjusted models, single clients [adjusted odds ratio (AOR) 1.80, 95{\%} confidence interval (CI) 1.06-3.06] and those with active tuberculosis (AOR 3.50, 95{\%} CI 1.55-6.61) were more likely to refuse ART. CONCLUSION:: Nearly one in five treatment-eligible HIV-infected individuals in Soweto refused to initiate ART after VCT, putting them at higher risk for early mortality. 'Feeling healthy' was given as the most common reason to refuse ART, despite a suppressed CD4 count and comorbidities such as tuberculosis. These findings highlight the urgent need for research to inform interventions targeting ART refusers.",
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N2 - OBJECTIVE:: To determine rates and predictors of treatment refusal in newly identified HIV-infected individuals in Soweto, South Africa. DESIGN:: It is designed as a cross-sectional study. METHODS:: We analyzed data from adult clients (>18 years) presenting for voluntary counseling and testing (VCT) at the Zazi Testing Center, Perinatal HIV Research Unit to determine rates of antiretroviral therapy (ART) refusal among treatment-eligible, HIV-infected individuals (CD4 cell count < 200 cells/μl or WHO stage 4). Multiple logistic regression models were used to investigate factors associated with refusal. RESULTS:: From December 2008 to December 2009, 7287 adult clients were HIV tested after counseling. Two thousand, five hundred and sixty-two (35%) were HIV-infected, of whom 743 (29%) were eligible for immediate ART. One hundred and forty-eight (20%) refused referral to initiate ART, most of whom (92%) continued to refuse after 2 months of counseling. The leading reason for ART refusal was given as 'feeling healthy' (37%), despite clients having a median CD4 cell count of 110 cells/μl and triple the rate of active tuberculosis as seen in nonrefusers. In adjusted models, single clients [adjusted odds ratio (AOR) 1.80, 95% confidence interval (CI) 1.06-3.06] and those with active tuberculosis (AOR 3.50, 95% CI 1.55-6.61) were more likely to refuse ART. CONCLUSION:: Nearly one in five treatment-eligible HIV-infected individuals in Soweto refused to initiate ART after VCT, putting them at higher risk for early mortality. 'Feeling healthy' was given as the most common reason to refuse ART, despite a suppressed CD4 count and comorbidities such as tuberculosis. These findings highlight the urgent need for research to inform interventions targeting ART refusers.

AB - OBJECTIVE:: To determine rates and predictors of treatment refusal in newly identified HIV-infected individuals in Soweto, South Africa. DESIGN:: It is designed as a cross-sectional study. METHODS:: We analyzed data from adult clients (>18 years) presenting for voluntary counseling and testing (VCT) at the Zazi Testing Center, Perinatal HIV Research Unit to determine rates of antiretroviral therapy (ART) refusal among treatment-eligible, HIV-infected individuals (CD4 cell count < 200 cells/μl or WHO stage 4). Multiple logistic regression models were used to investigate factors associated with refusal. RESULTS:: From December 2008 to December 2009, 7287 adult clients were HIV tested after counseling. Two thousand, five hundred and sixty-two (35%) were HIV-infected, of whom 743 (29%) were eligible for immediate ART. One hundred and forty-eight (20%) refused referral to initiate ART, most of whom (92%) continued to refuse after 2 months of counseling. The leading reason for ART refusal was given as 'feeling healthy' (37%), despite clients having a median CD4 cell count of 110 cells/μl and triple the rate of active tuberculosis as seen in nonrefusers. In adjusted models, single clients [adjusted odds ratio (AOR) 1.80, 95% confidence interval (CI) 1.06-3.06] and those with active tuberculosis (AOR 3.50, 95% CI 1.55-6.61) were more likely to refuse ART. CONCLUSION:: Nearly one in five treatment-eligible HIV-infected individuals in Soweto refused to initiate ART after VCT, putting them at higher risk for early mortality. 'Feeling healthy' was given as the most common reason to refuse ART, despite a suppressed CD4 count and comorbidities such as tuberculosis. These findings highlight the urgent need for research to inform interventions targeting ART refusers.

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