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P6.042 ART Uptake and CD4 Recovery Rates Post ART Initiation in a Cohort of HIV-1 Infected Individuals Referred For ART at Jinja Partners PREP Site
  1. S Mubezi1,
  2. S Khasaka1,
  3. F Nsanga1,
  4. W Musubika1,
  5. P Ssenkungu1,
  6. E Katabira1,2,
  7. P Ndase1,3,
  8. P Shuha1
  1. 1Jinja Partners PrEP Study, Makerere University, Infectious Diseases Institute, Jinja, Uganda
  2. 2Department of Medicine, Makerere University College of Health Sciences, Kampala, Uganda
  3. 3Department of Global Health, University of Washington, Seattle, WA, United States

Abstract

Background The current WHO recommendation for ART initiation at CD4 cell count ≤ 350 is premised on the need for achieving better immune recovery. However, not every HIV infected person meeting this threshold is able to start ART in a timely manner.

Methods We retrospectively analysed ART initiation trends and CD4 responses of HIV-1 infected participants enrolled from the Jinja, Uganda site of the Partners PrEP Study. The Partners PrEP study was a phase III, randomised, placebo-controlled trial of daily oral tenofovir and emtricitabine/tenofovir PrEP among HIV-uninfected members of HIV-1 serodiscordant relationships.

Results Between June 2009 and September 2012, 37.7% (116/308) of HIV-1 infected participants met national threshold for ART initiation and were referred for ART initiation. Over this 39 month period, 64.7% (75/116) of referred participants initiated ART while 35.3% (41/116) never started ART for various reasons. 84% (63/75) of those initiated on ART had at least two consecutive 6 monthly CD4 test results available. 79.4% (50/63) were on zidovudine based regimens while 20.6% (13/63) were on tenofovir based regimens. Median pre-ART CD4 baseline was 231 Cells/ul. After 6 months of ART initiation, 54% (34/63) of participants noted > 50% increase in CD4 while 33.3% (21/63) noted < 50% increase in CD4. After 12 months of ART initiation, 66.7% (42/63) of participants registered > 50% increase in CD4 while 27% (17/63) registered < 50% increase in CD4. 12.7% (8/63) and 6% (4/63) of participants initiated on ART showed a decline from pre-ART CD4 baseline at 6 and 12months respectively. Tenofovir & zidovudine based regimens were equivalent in achieving CD4 recovery.

Conclusion Our findings highlight the need for addressing potential structural and individual barriers to ART care (only 64.7% of cases referred for ART initiated treatment). Two-thirds of those initiated on ART more than doubled their CD4 counts at 12 months post-ART initiation.

  • ART initiation trends
  • CD4 recovery rates
  • structural barrier to ART initiation

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