@article{PAR00010629,
  title = {{F}actors associated with late antiretroviral therapy initiation in {C}ameroon : a representative multilevel analysis},
  author = {{N}dawinz, {J}. {D}. and {C}haix, {B}. and {K}oulla-{S}hiro, {S}. and {D}elaporte, {E}ric and {O}kouda, {B}. and {A}banda, {A}. and {T}chomthe, {S}. and {M}boui, {E}. and {C}ostagliola, {D}. and {S}upervie, {V}.},
  editor = {},
  language = {{ENG}},
  abstract = {{M}any people living with {HIV}/{AIDS} in resource-limited settings begin antiretroviral therapy ({ART}) at low {CD}4 counts. {H}ere, we investigated the simultaneous effect of individual-, facility- and regional-level factors on late {ART} initiation. {W}e conducted a survey in a nationally representative sample of 55 {HIV} treatment facilities in {C}ameroon. {M}edical records of 4935 patients 15 years of age who initiated {ART} in the month of {O}ctober during the period 200710 were reviewed to gather individual characteristics. {L}ate {ART} initiation was defined as {CD}4 count 100 cells/mm(3). {F}acility- and regional-level characteristics were also collected. {T}wo-level regression logistic models were used to identify factors associated with late {ART} initiation. {L}ate {ART} initiation was associated with being a male younger than 45 years versus female younger than 45 years [adjusted {OR} ({AOR})1.5, 95 {CI}: 1.31.7] and initiating {ART} in the period 200709 versus 2010 ({AOR}1.2, 95 {CI}: 1.01.4). {L}ate initiation was more likely in central than in district hospitals ({AOR}1.3, 95 {CI}: 1.11.6) and in hospitals without a mother-to-child transmission programme ({AOR}1.9, 95 {CI}: 1.32.8). {L}iving in a region with a higher comprehensive knowledge of {HIV}/{AIDS} was associated with not initiating {ART} late ({AOR}0.8, 95 {CI}: 0.61.0). {T}his study shows that risk factors associated with late {ART} initiation operate at multiple levels and that multilevel interventions are therefore necessary to promote earlier {HIV} testing and treatment.},
  keywords = {sub-{S}aharan {A}frica ; people living with {HIV} ; {AIDS} ; {HIV} treatment ; risk ; factors ; multivariate analysis ; {CAMEROUN}},
  booktitle = {},
  journal = {{J}ournal of {A}ntimicrobial {C}hemotherapy},
  volume = {68},
  numero = {6},
  pages = {1388--1399},
  ISSN = {0305-7453},
  year = {2013},
  DOI = {10.1093/jac/dkt011},
  URL = {https://www.documentation.ird.fr/hor/{PAR}00010629},
}