Assessing Timely Presentation to Care Among People Diagnosed with HIV During Hospital Admission: A Population-Based Study in Ontario, Canada

Abstract

Timely presentation to care for people newly diagnosed with HIV is critical to optimize health outcomes and reduce onward HIV transmission. Studies describing presentation to care following diagnosis during a hospital admission are lacking. We sought to assess the timeliness of presentation to care and to identify factors associated with delayed presentation. We conducted a population-level study using health administrative databases. Participants were all individuals older than 16 and newly diagnosed with HIV during hospital admission in Ontario, Canada, between April 1, 2007 and March 31, 2015. We used modified Poisson regression models to derive relative risk ratios for the association between sociodemographic and clinical variables and the presentation to out-patient HIV care by 90 days following hospital discharge. Among 372 patients who received a primary HIV diagnosis in hospital, 83.6% presented to care by 90 days. Following multivariable analysis, we did not find associations between patient sociodemographic or clinical characteristics and presentation to care by 90 days. In a secondary analysis of 483 patients diagnosed during hospitalization but for whom HIV was not recorded as the principal reason for admission, 73.1% presented to care by 90 days. Following multivariable adjustment, we found immigrants from countries with generalized HIV epidemics (RR 1.265, 95% CI 1.133-1.413) were more likely to present to care, whereas timely presentation was less likely for people with a mental health diagnosis (RR 0.817, 95% CI 0.742-0.898) and women (RR 0.748, 95% CI 0.559-1.001). Future work should evaluate mechanisms to facilitate presentation to care among these populations.

Profile and outcome of multiple myeloma with and without HIV treated at a tertiary hospital in KwaZulu-Natal, South Africa

“…In Canada, it is reported that approximately 70–80% of patients diagnosed, during hospitalisation, with either HIV disease or other diseases managed to follow-up back to hospital within 3 months [ 43 ]. In contrast, other Canadian data showed that late presentation and late diagnosis (defined as a duration greater than 3 months from diagnosis to presentation to care) were noted in approximately 50% of patients, similar to other high-income countries.…”

“…In contrast, other Canadian data showed that late presentation and late diagnosis (defined as a duration greater than 3 months from diagnosis to presentation to care) were noted in approximately 50% of patients, similar to other high-income countries. This late presentation was associated with African descent and surprisingly, female gender [ 43 – 46 ]. In other first-world countries, in an Embase and Medline meta-analysis, an interval of 163 days from first symptoms to diagnosis in MM is reported [ 47 ].…”

The associations of population mobility in HIV disease severity and mortality rate in China

“…Previous studies have indicated differences in occupation, income, and education level in different populations (5,7,(33)(34)(35)(36) and have demonstrated that migrant populations lack awareness of HIV prevention and treatment (16,37). Therefore, migrant patients are at higher risk of having HIV infection and of spreading the disease.…”

Delayed HIV diagnosis of patients due to the COVID-19 pandemic

“…Due to the COVID-19 pandemic, HIV diagnosis and treatment were often delayed [2]. Initial diagnosis of HIV which occurs on time is essential in order to start treatment early and prevent further progression of the disease [7]. The presence of indicator diseases of AIDS should force HIV test.…”