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Abstract：
Despite a decade of advancing HIV/AIDS treatment policy in South Africa, 20% of people living with HIV (PLHIV) eligible for antiretroviral treatment (ART) remain untreated. To inform universal test and treat (UTT) implementation in South Africa, this analysis describes the rate, timeliness and determinants of ART initiation among newly diagnosed PLHIV. This analysis used routine data from 35 purposively selected primary clinics in three high HIV-burden districts of South Africa from June 1, 2014 to March 31, 2015. Kaplan-Meier survival curves estimated the rate of ART initiation. We identified predictors of ART initiation rate and timely initiation (within 14 days of eligibility determination) using Cox proportional hazards and multivariable logistic regression models in Stata 14.1. Based on national guidelines, 6826 patients were eligible for ART initiation. Under half of men and non-pregnant women were initiated on ART within 14 days (men: 39.7.0%, 95% CI 37.7-41.9; women: 39.9%, 95% CI 38.1-41.7). Pregnant women initiated at a faster rate (within 14 days: 87.6%, 86.1-89.0). ART initiation and timeliness varied significantly by district, facility location, and age, with little to no variation by World Health Organization stage, or CD4 count. Men and non-pregnant women newly diagnosed with HIV who are eligible for ART in South Africa show suboptimal timeliness of ART initiation. If treatment initiation performance is not improved, UTT implementation will be challenging among men and non-pregnant women. UTT programming should be tailored to district and location categories to address contextual differences influencing treatment initiation.
摘要：
尽管南非推进了十年的艾滋病毒/艾滋病治疗政策，有资格接受抗逆转录病毒治疗（ART）的艾滋病毒感染者（PLHIV）中有20％仍未得到治疗。为南非的通用测试和治疗（UTT）实施提供信息，这个分析描述了利率，新诊断的PLHIV中ART启动的及时性和决定因素。该分析使用了2014年6月1日至2015年3月31日南非三个艾滋病毒高负担地区35个有目的地选择的初级诊所的常规数据。Kaplan-Meier存活曲线估计ART起始率。我们在Stata14.1中使用Cox比例风险和多变量逻辑回归模型确定了ART启动率和及时启动（在资格确定的14天内）的预测因子。根据国家指导方针，6826例患者有资格开始ART。不到一半的男性和非孕妇在14天内接受了ART（男性：39.7.0%，95%CI37.7-41.9；女性：39.9%，95%CI38.1-41.7）。孕妇以更快的速度开始（在14天内：87.6％，86.1-89.0)。ART的启动和及时性因地区而异，设施位置,和年龄,世界卫生组织阶段几乎没有变化，或CD4计数。在南非，新诊断为艾滋病毒的男性和非孕妇有资格接受ART，其ART启动的及时性欠佳。如果治疗启动性能没有得到改善，UTT的实施在男性和非孕妇中具有挑战性。UTT编程应针对地区和位置类别进行调整，以解决影响治疗开始的上下文差异。
