TY - JOUR
T1 - Delayed HIV diagnosis and initiation of antiretroviral therapy: inequalities by educational level, COHERE in EuroCoord
AU - Lodi, Sara
AU - Dray-Spira, Rosemary
AU - Touloumi, Giota
AU - Braun, Dominique
AU - Teira, Ramon
AU - D'Arminio Monforte, Antonella
AU - Gallois, Anne
AU - Zangerle, Robert
AU - Spire, Bruno
AU - Dabis, Francois
AU - Stähelin, Cornelia
AU - Termote, Monique
AU - Kirk, Ole
AU - Chêne, Genevieve
AU - Egger, Matthias
AU - del Amo, Julia
AU - AUTHOR GROUP
AU - Warszawski, Josiane
AU - Meyer, Laurence
AU - Dabis, François
AU - Krause, Murielle Mary
AU - Ghosn, Jade
AU - Leport, Catherine
AU - Reiss, Peter
AU - Wit, Ferdinand
AU - Prins, Maria
AU - Bucher, Heiner
AU - Sabin, Caroline
AU - Gibb, Diana
AU - Fätkenheuer, Gerd
AU - Obel, Niels
AU - Thorne, Claire
AU - Mocroft, Amanda
AU - Stephan, Christoph
AU - Pérez-Hoyos, Santiago
AU - Hamouda, Osamah
AU - Bartmeyer, Barbara
AU - Noguera-Julian, Antoni
AU - Antinori, Andrea
AU - Brockmeyer, Norbert
AU - Ramos, José
AU - Conejo, Pablo Rojo
AU - Soriano, Toni
AU - Battegay, Manuel
AU - Rauch, Andri
AU - Mussini, Cristina
AU - Tookey, Pat
AU - Casabona, Jordi
AU - Miró, Jose M.
AU - Castagna, Antonella
AU - van der Valk, Marc
PY - 2014
Y1 - 2014
N2 - Objectives:In Europe and elsewhere, health inequalities among HIV-positive individuals are of concern. We investigated late HIV diagnosis and late initiation of combination antiretroviral therapy (cART) by educational level, a proxy of socioeconomic position.Design and methods:We used data from nine HIV cohorts within COHERE in Austria, France, Greece, Italy, Spain and Switzerland, collecting data on level of education in categories of the UNESCO/International Standard Classification of Education standard classification: non-completed basic, basic, secondary and tertiary education. We included individuals diagnosed with HIV between 1996 and 2011, aged at least 16 years, with known educational level and at least one CD4(+) cell count within 6 months of HIV diagnosis. We examined trends by education level in presentation with advanced HIV disease (AHD) (CD4(+) <200cells/l or AIDS within 6 months) using logistic regression, and distribution of CD4(+) cell count at cART initiation overall and among presenters without AHD using median regression.Results:Among 15414 individuals, 52, 45,37, and 31% with uncompleted basic, basic, secondary and tertiary education, respectively, presented with AHD (P trend <0.001). Compared to patients with tertiary education, adjusted odds ratios of AHD were 1.72 (95% confidence interval 1.48-2.00) for uncompleted basic, 1.39 (1.24-1.56) for basic and 1.20 (1.08-1.34) for secondary education (P <0.001). In unadjusted and adjusted analyses, median CD4(+) cell count at cART initiation was lower with poorer educational level.Conclusions:Socioeconomic inequalities in delayed HIV diagnosis and initiation of cART are present in European countries with universal healthcare systems and individuals with lower educational level do not equally benefit from timely cART initiation
AB - Objectives:In Europe and elsewhere, health inequalities among HIV-positive individuals are of concern. We investigated late HIV diagnosis and late initiation of combination antiretroviral therapy (cART) by educational level, a proxy of socioeconomic position.Design and methods:We used data from nine HIV cohorts within COHERE in Austria, France, Greece, Italy, Spain and Switzerland, collecting data on level of education in categories of the UNESCO/International Standard Classification of Education standard classification: non-completed basic, basic, secondary and tertiary education. We included individuals diagnosed with HIV between 1996 and 2011, aged at least 16 years, with known educational level and at least one CD4(+) cell count within 6 months of HIV diagnosis. We examined trends by education level in presentation with advanced HIV disease (AHD) (CD4(+) <200cells/l or AIDS within 6 months) using logistic regression, and distribution of CD4(+) cell count at cART initiation overall and among presenters without AHD using median regression.Results:Among 15414 individuals, 52, 45,37, and 31% with uncompleted basic, basic, secondary and tertiary education, respectively, presented with AHD (P trend <0.001). Compared to patients with tertiary education, adjusted odds ratios of AHD were 1.72 (95% confidence interval 1.48-2.00) for uncompleted basic, 1.39 (1.24-1.56) for basic and 1.20 (1.08-1.34) for secondary education (P <0.001). In unadjusted and adjusted analyses, median CD4(+) cell count at cART initiation was lower with poorer educational level.Conclusions:Socioeconomic inequalities in delayed HIV diagnosis and initiation of cART are present in European countries with universal healthcare systems and individuals with lower educational level do not equally benefit from timely cART initiation
U2 - https://doi.org/10.1097/QAD.0000000000000410
DO - https://doi.org/10.1097/QAD.0000000000000410
M3 - Article
C2 - 25313585
SN - 0269-9370
VL - 28
SP - 2297
EP - 2306
JO - AIDS (London, England)
JF - AIDS (London, England)
IS - 15
ER -