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Are there gender differences in ART seeking and receipt? Evidence from a population cohort in Rakai, Uganda
Presented by Jackson Musuuza, Uganda.
Musuuza J.1, Kigozi G.2, Galiwango R.1, Reynolds S.3, Ndyanabo A.4, Serwadda D.5, Nalugoda F.2, Gray R.6, Wawer M.6, Kiwanuka N.7
1Rakai Health Sciences Program, Anti Retroviral Therapy Department, Kampala, Uganda, 2Rakai Health Sciences Program, Management, Kampala, Uganda, 3NIAID, NIH Baltimore, Management, Baltimore, United States, 4Rakai Health Sciences Program, Kampala, Uganda, 5Makerere University Institute of Public Health, Management, Kampala, Uganda, 6Johns Hopkins School of Medicine, Medicine, Baltimore, United States, 7Case Western University, Cleveland, OH, USA, Management, Kampala, Uganda
Background: Reports that a much lower proportion of men than women in sub-Saharan Africa are seeking antiretroviral therapy may be biased by use of clinic-based data which lack the total number eligible for treatment in the source populations.
Objective: To assess gender differences in seeking and receipt of ART among individuals eligible for ART treatment in a longitudinal population cohort in Rakai, Uganda.
Methods: HIV infected individuals in Rakai cohort are referred to the HIV treatment program for care that includes Co-trimoxazole prophylaxis, antiretroviral therapy (ART), insecticide impregnated bed nets, and water purification. Those with CD4 counts £250 cells/mm3 are started on ART. Care is provided through 16 community-based clinics.
Results: Among 13284 cohort participants at survey round 11 (Feb 2005-June 2006), HIV prevalence in women was 13.7% (1038/7599), in men 9.5% (541/5685); PRR=1.43 (95% CI 1.28-1.60). More women than men went to HIV clinics (46% and 35%, respectively, P<0.001). However, eligibility for ART is based on CD4 counts or WHO clinical staging and among those with CD4 data, 23% (152/651) of HIV positive women and 27.6% (82/297) of men had counts £250 cells/mm3, P=0.17. The proportion of those eligible for ART that initiated treatment was 59.9% (91/152) and 53.7% (44/82); P=0.41
Conclusions: Using population cohort data we found no differences in the proportion of men and women receiving ART in Rakai.
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