Abstract

TUPE081 - Poster Exhibition

Patient attitudes toward initiating early antiretroviral therapy at high CD4+ cell counts above national guideline thresholds

V. Jain^1,2, D. Byonanebye^2,3, J. Muhaawe², J. Kabami², D. Black^1,2, T. Clark^1,2, G. Chamie^1,2, E. Geng^1,2, H. Thirumurthy⁴, J. Rooney⁵, E. Charlebois^1,2, G. Amanyire^2,3, D.V. Havlir^1,2, M. Kamya^2,6, SEARCH Consortium

¹University of California, San Francisco, HIV/AIDS Division, San Francisco General Hospital, San Francisco, United States, ²Makerere University-University of California, San Francisco (MU-UCSF) Research Collaboration, Kampala/Mbarara, Uganda, ³Mulago-Mbarara Joint AIDS Program, Mbarara, Uganda, ⁴Gillings School of Global Public Health, University of North Carolina, Chapel Hill, United States, ⁵Gilead Sciences, Foster City, United States, ⁶Makerere University College of Health Sciences, Department of Medicine, School of Medicine, Kampala, Uganda

Background: As evidence mounts favoring earlier antiretroviral therapy (ART) initiation, understanding patient attitudes towards initiating ART at high CD4 counts in Sub-Saharan Africa above guideline thresholds is important: little is known about why patients might opt for therapy if eligible while still healthy and asymptomatic. Within a trial in Uganda evaluating the efficacy and cost of early ART initiation at high CD4 counts, we assessed patient attitudes towards starting ART.
Methods: Patients receiving HIV care but not yet eligible for ART in a rural Western Ugandan clinic (CD4>250 in 2011) were screened for a study assessing ART initiation prior to guideline eligibility (EARLI Study: NCT01479634). Inclusion criteria were CD4>250 (no CD4 upper limit), no WHO stage 3/4 conditions, and no prior ART. A systematic survey was conducted at study enrollment, prior to ART. Eight questions explored reasons for consenting to early ART, and the proportion of respondents identifying each reason was tabulated. No enrollment incentives were provided.
Results: Of 112 patients screened, 98 were eligible for entry and 94/98 (96%) chose to enroll and initiate ART (n=20 with CD4 250-350, and n=74 with CD4>350). Median CD4 among ART initiators was 506 (IQR 354-669). The most prevalent reasons given for initiating early ART related to preserving health and productivity: 87% cited a desire to stay healthy, 53% to continue working, and 52% to continue caring for family. Secondary reasons included avoiding transmission to others (29%) or to children (26% of females). Finally, 9% cited feeling unwell, and 7% cited their spouse/partner was taking ART as reasons for enrolling.
Conclusions: In healthy patients successfully linked to HIV care with high CD4 counts (median CD4=506), we observed very strong interest in initiating ART if available. Preserving health and economic productivity, and avoiding transmission, were key reasons for seeking early ART at high CD4 counts.