Abstract:
Current guidelines recommend starting antiretroviral therapy (ART) as soon as possible after HIV
diagnosis to reduce morbidity, mortality and onward HIV transmission. We examined factors
influencing ART initiation by women who seroconverted during the Evidence for Contraceptive
Options and HIV Outcomes (ECHO) Trial. ECHO, conducted between 2015 and 2018, enrolled
HIV-negative, sexually active women, aged 16–35 years, from four African countries. Follow-up
was 12–18 months, with quarterly HIV testing. Women with incident HIV infection received
extensive counselling by trial staff and referral to local facilities for HIV care. Of 304 women with
≥90 days follow-up time since HIV diagnosis, 186(61.2%) initiated ART within 90 days, 69(22.7%)
initiated after 90 days, and 49(16.1%) had not initiated by the end of the study. There were no
statistically significant differences in characteristics among women who initiated ART ≤90 days
versus those who did not. Frequent reasons for delayed or non-initiation of ART included not
feeling ready to start ART and being newly diagnosed. In a large clinical trial, ART initiation was
modest within 90 days of HIV diagnosis and grew to 84% with longer observation. Despite
extensive counselling on the importance of early ART initiation, personal barriers delayed some
women from starting ART.
