Understanding the delay in starting antiretroviral therapy despite recent guidelines for HIV patients retained in care
Bibliographic record
Abstract
Despite strong evidence of a clinical benefit from initiating antiretroviral therapy (ART) immediately after diagnosis some patients remain ART naïve. We examined explanations, over a four-year period in a centralized HIV clinical cohort under universal health care, for newly diagnosed patients, while being fully engaged and retained in HIV care, delaying ART initiation for >180 days following their HIV diagnosis. All patients followed at the Southern Alberta Clinic, Calgary, Canada between 1 January 2010 and 1 January 2014 were included and followed until they moved, were lost to follow-up, died or until 1 January 2015. Of 269 patients, 56 (21.8%) deferred ART >180 days; 26 (9.7%) remained ART naïve until the end of the study. Patients delaying or deferring ART were younger, Canadian-born, and with higher CD4 counts (p < .01). "No clinical urgency" especially for patients with higher CD4 counts, was most often listed for deferring ART, however when ART was offered "patient not ready", "unstable substance use", "difficulties adjusting" or "wanting to wait" were often cited regardless of CD4 levels. At times ART, when offered, was adamantly declined by the patient. The physician's assessment of a patient's ability to adhere to lifelong ART was an issue in some cases. While structural or financial issues may impact ART initiation, our results suggest that, even in an environment of free and easy access to ART, many challenges still exist at the implementation stage. Intense efforts in both patient and physician education will be required if the benefits of early ART as recommended by the WHO in their recent guidelines, are to be achieved at the individual and population level.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.003 | 0.028 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.000 | 0.000 |
| Bibliometrics | 0.001 | 0.001 |
| Science and technology studies | 0.001 | 0.001 |
| Scholarly communication | 0.002 | 0.002 |
| Open science | 0.001 | 0.001 |
| Research integrity | 0.001 | 0.002 |
| Insufficient payload (model declined to judge) | 0.002 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".