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.