Table 3.
Bivariate and multivariable associations between participants’ characteristics and late ART initiationa
| Bivariate | Multivariable Model 1 (N=1171)b | Multivariable Model 2 (N=1174)c | ||
|---|---|---|---|---|
| n | OR (95% CI) | aOR (95% CI) | aOR (95% CI) | |
| Predisposing factors | ||||
| Sex (ref: non-pregnant women, n=669) | ||||
| Men | 458 | 2.34 (1.81 to 3.03) | 2.29 (1.73 to 3.02) | 2.02 (1.50 to 2.73) |
| Pregnant women | 53 | 0.44 (0.19 to 1.00) | 0.41 (0.18 to 0.97) | 0.53 (0.21 to 1.33) |
| Age at ART initiation (ref: 18 to 29, n=374) | ||||
| 30 to 39 | 482 | 1.63 (1.21 to 2.19) | 1.27 (0.92 to 1.75) | 1.25 (0.88 to 1.77) |
| 40 to 49 | 238 | 1.29 (0.90 to 1.85) | 0.91 (0.61 to 1.35) | 0.92 (0.60 to 1.40) |
| 50 + | 86 | 1.14 (0.67 to 1.93) | 0.72 (0.41 to 1.26) | 0.60 (0.33 to 1.10) |
| Education level (ref: primary school or vocational/other, n=484) | ||||
| No school | 374 | 0.78 (0.57 to 1.05) | ||
| Secondary school | 239 | 1.09 (0.78 to 1.51) | ||
| University | 83 | 1.16 (0.71 to 1.91) | ||
| Relationship status (ref: in a relationship, n=673) | ||||
| Not in a relationship | 507 | 1.15 (0.90 to 1.48) | ||
| Has ever had children (ref: no, n=253) | ||||
| Yes | 926 | 0.78 (0.58 to 1.05) | ||
| Alcohol use (ref: low or none, n=916) | ||||
| High | 162 | 1.59 (1.12 to 2.26) | ||
| Moderate | 102 | 1.06 (0.68 to 1.67) | ||
| Psychological distress (ref: low or none, n=480) | ||||
| Medium | 348 | 1.93 (1.41 to 2.66) | 1.76 (1.27 to 2.46) | 1.61 (1.12 to 2.31) |
| High | 347 | 2.91 (2.08 to 4.07) | 2.70 (1.90 to 3.85) | 1.96 (1.34 to 2.87) |
| Enacted stigma (ref: none, n=983) | ||||
| Any | 192 | 1.05 (0.74 to 1.48) | ||
| Internalized stigma (ref: top tercile/least stigma, n=469) | ||||
| Bottom tercile (=most stigma) | 395 | 1.44 (1.06 to 1.94) | ||
| Middle tercile | 310 | 1.24 (0.90 to 1.70) | ||
| History of holy water use for HIV (ref: no, n=840) | ||||
| Yes | 189 | 0.69 (0.48 to 0.99) | ||
| Treatment beliefs (ref: low accuracy, n=118) | ||||
| High accuracy | 1061 | 0.86 (0.56 to 1.32) | ||
| Enabling factors | ||||
| Area of residence (ref: rural, n=259) | ||||
| Urban | 920 | 0.79 (0.59 to 1.07) | ||
| Trouble satisfying food needs in last year (ref: never, n=422) | ||||
| Sometimes | 502 | 0.91 (0.68 to 1.22) | ||
| Often | 252 | 0.84 (0.59 to 1.19) | ||
| Knows someone on ART (ref: no, n=368) | ||||
| Yes | 809 | 0.73 (0.56 to 0.95) | 0.77 (0.57 to 1.04) | |
| Number of people disclosed to (ref: 0, n=167) | ||||
| 1 | 422 | 0.79 (0.55 to 1.15) | 1.00 (0.67 to 1.49) | |
| ≥ 2 | 591 | 0.57 (0.40 to 0.82) | 0.69 (0.46 to 1.02) | |
| Social support (ref: bottom quarter/least support; n=298) | ||||
| Second quarter | 305 | 0.91 (0.64 to 1.28) | ||
| Third quarter | 292 | 0.84 (0.59 to 1.19) | ||
| Top quarter (= most support) | 285 | 0.90 (0.62 to 1.30) | ||
| Communication barriers with providers (ref: no, n=1127) | ||||
| Yes | 53 | 2.27 (1.30 to 3.97) | 2.43 (1.32 to 4.48) | 2.42 (1.24 to 4.75) |
| Perceived need | ||||
| Tested for HIV because partner sick/dead/HIV+ (ref: no, n=930) | ||||
| Yes | 250 | 0.38 (0.27 to 0.55) | 0.47 (0.32 to 0.69) | 0.64 (0.42 to 0.95) |
| Clinical characteristics | ||||
| Enrolment point of entry (ref: VCT, n=493) | ||||
| PMTCT | 45 | 0.31 (0.11 to 0.88) | – | 0.56 (0.18 to 1.72) |
| PITC | 491 | 1.80 (1.36 to 2.39) | – | 1.47 (1.07 to 2.04) |
| Other, including TB clinic | 32 | 2.15 (1.03 to 4.49) | – | 1.85 (0.73 to 4.71) |
| Unknown | 119 | 2.22 (1.45 to 3.42) | – | 1.70 (1.04 to 2.77) |
| History of TB treatment in HIV care (ref: no, n=1030) | ||||
| Yes | 150 | 2.93 (2.07 to 4.16) | – | 2.16 (1.43 to 3.25) |
| Gap in care of six months or more prior to ART (ref: no, n=260) | ||||
| Yes | 260 | 2.41 (1.35 to 4.33) | – | 2.02 (1.10 to 3.72) |
| Initiated ART during first six months in care | 659 | 11.64 (7.04 to 19.25) | – | 8.98 (5.34 to 15.08) |
aOR, adjusted odds ratio; ART, antiretroviral therapy; OR, odds ratio; VCT, voluntary counselling and testing; PMTCT, prevention of mother-to-child transmission; PITC, provider-initiated testing and counselling; TB, tuberculosis
a
late ART initiation is defined as having a CD4+ cell count <150 cells/µL or WHO Stage IV. Analyses account for site-level clustering. Statistically significant associations (p<0.05) in bold
b
multivariable Model 1 includes only psychosocial factors
c
multivariable Model 2 is final, combining psychosocial and clinical factors.