High acceptability of earlier ART among South African women

30 May 2018

Both WHO and South African guidelines recommend immediate initiation of antiretroviral therapy (ART) for all individuals at HIV diagnosis regardless of CD4 count, but concerns remain about potential low uptake or poor adherence among healthy patients with high CD4 counts, especially in resource-limited settings. This study assessed the acceptability of earlier treatment among young HIV-positive South African women who seroconverted and enrolled in the CAPRISA 002 study, a 12-year longitudinal cohort study.

     Acceptability was assessed by (a) describing temporal CD4 count trends at initiation in relation to WHO guidance, (b) virological suppression rates post-ART initiation at different CD4 count thresholds, and (c) administration of a standardized questionnaire.

     A total of 158/232 (68.1%) participants initiated ART between 2006 and 2015. Mean CD4 count at initiation was 217 cells/µl before 2010, and increased to 531 cells/µl by 2015 (p < 0.001). Median viral load at ART initiation decreased over this period from 5.2 to 4.1 log copies/ml (p = 0.004) (Figure 1). Virological suppression rates at 3, 6, 12 and 18 months were consistently above 85% with no significant differences for participants starting ART at different CD4 count thresholds. A questionnaire assessing uptake of early ART amongst HIV positive, ART-naïve women revealed that 40/51 (78.4%) were willing to start ART at CD4 ≥500. Of those unwilling, 6/11 (54.5%) started ART within 6 months of questionnaire administration.

     Temporal increases in CD4 counts, comparable virological suppression rates, and positive patient perceptions confirm high acceptability of earlier ART initiation for the majority of