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Using data from an 8-month prospective cohort interview study of women and men newly-diagnosed with HIV in three public-sector primary care clinics in the eThekwini (Durban) region, South Africa, 2010\u20132014, we examined if theoretically-relevant social-structural, social-cognitive, psychosocial, and health status indicators were associated with time to ART initiation. Of 459 diagnosed, 350 returned to the clinic for their CD4+ test results (linkage); 153 (33.3%) were ART-eligible according to treatment criteria at the time; 115 (75.2% of those eligible) initiated ART (median = 12.86 weeks [95% CI: 9.75, 15.97] after linkage). In adjusted Cox proportional hazard models, internalized stigma was associated with a 65% decrease in the rate of ART initiation (Adjusted hazard ratio [AHR] 0.35, 95% CI: 0.19\u20130.80) during the period less than four weeks after linkage to care, but not four or more weeks after linkage to care, suggesting that stigma-reduction interventions implemented shortly after diagnosis may accelerate ART uptake. As reported by others, older age was associated with more rapid ART initiation (AHR for 1-year age increase: 1.04, 95% CI: 1.01\u20131.07) and higher CD4+ cell count (\u2265300\u03bcL vs. &lt;150\u03bcL) was associated with a lower rate of initiation (AHR 0.38, 95% CI: 0.19\u20130.80). Several other factors that were assessed prior to diagnosis, including stronger belief in traditional medicine, higher endorsement of stigma toward people living with HIV, food insecurity, and higher psychological distress, were found to be in the expected direction of association with ART initiation, but confidence intervals were wide and could not exclude a null finding.<\/jats:p>","DOI":"10.1371\/journal.pone.0246744","type":"journal-article","created":{"date-parts":[[2021,2,20]],"date-time":"2021-02-20T04:33:42Z","timestamp":1613795622000},"page":"e0246744","update-policy":"https:\/\/doi.org\/10.1371\/journal.pone.corrections_policy","source":"Crossref","is-referenced-by-count":5,"title":["Predictors of antiretroviral therapy initiation in eThekwini (Durban), South Africa: Findings from a prospective cohort study"],"prefix":"10.1371","volume":"16","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-0608-9811","authenticated-orcid":true,"given":"Karla Therese L.","family":"Sy","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Shema","family":"Tariq","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Gita","family":"Ramjee","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Kelly","family":"Blanchard","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Cheng-Shiun","family":"Leu","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Elizabeth A.","family":"Kelvin","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Theresa M.","family":"Exner","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Anisha D.","family":"Gandhi","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Naomi","family":"Lince-Deroche","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Joanne E.","family":"Mantell","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Lucia F.","family":"O\u2019Sullivan","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Susie","family":"Hoffman","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"340","published-online":{"date-parts":[[2021,2,19]]},"reference":[{"issue":"8","key":"pone.0246744.ref001","doi-asserted-by":"crossref","first-page":"1133","DOI":"10.1086\/586713","article-title":"Major clinical outcomes in antiretroviral therapy (ART)-naive participants and in those not receiving ART at baseline in the SMART study","volume":"197","author":"S Emery","year":"2008","journal-title":"The Journal of infectious diseases"},{"issue":"6","key":"pone.0246744.ref002","doi-asserted-by":"crossref","first-page":"493","DOI":"10.1056\/NEJMoa1105243","article-title":"Prevention of HIV-1 infection with early antiretroviral therapy","volume":"365","author":"MS Cohen","year":"2011","journal-title":"The New England journal of medicine"},{"issue":"6","key":"pone.0246744.ref003","doi-asserted-by":"crossref","first-page":"284","DOI":"10.1310\/hct1406-284","article-title":"Early virologic response to abacavir\/lamivudine and tenofovir\/emtricitabine during ACTG A5202","volume":"14","author":"PM Grant","year":"2013","journal-title":"HIV clinical trials"},{"key":"pone.0246744.ref004","unstructured":"World Health Organization. Guideline on when to start antiretroviral therapy and on pre-exposure prophylaxis for HIV. 2015. Available from: https:\/\/apps.who.int\/iris\/bitstream\/handle\/10665\/186275\/9789241509565_eng.pdf?sequence=1."},{"key":"pone.0246744.ref005","unstructured":"Dr. Y. Pillay, Deputy Director-General: HIV and AIDS, TB, and MCWH, Dr. A. Pillay, Deputy Director-General: Health Regulation and Compliance Management. Re: Implementation of the universal test and treat strategy for HIV positive patients and differentiated care for stable patients [Internet] 2016. 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