Barriers to early diagnosis and treatment of severely immunosuppressed patients with HIV‐1 infection: A quantitative and qualitative study

Abstract

Objectives To explore the barriers to early diagnosis of HIV infection and timely initiation of antiretroviral therapy (ART). Methods We assessed the annual number and proportion of ART‐naïve people living with HIV infection (PLWH) with severe immunosuppression in Shenzhen, China, from 2008 to 2019. Selected ART‐naïve PLWHs with severe immunosuppression who were seeking treatment for the first time in the hospital in 2019 were subjected to an in‐depth interview. Results The proportion of severely immunosuppressed, ART‐naïve PLWH decreased from 36.73% in 2008 to 8.94% in 2015, and then plateaued at approximately 10% from 2015 to 2019. Overall, 55 patients, 70% of whom were men who had sex with men, participated in the qualitative interviews. Ten of them delayed treatment after diagnosis, with a median [interquartile range (IQR)] interval of 5.83 (3.98–8.54) years between diagnosis and ART. More than 80% of the patients reported casual sexual contact within a median period of 6 years and with a median (IQR) of nine (4–20) casual sex partners. The major barriers to HIV testing and diagnosis included lack of knowledge about HIV and high‐risk behaviours, low awareness about HIV testing, and resistance to HIV testing. The major barriers to ART initiation included lack of knowledge about the importance of ART and change of national ART eligibility policy, and HIV‐related stress. Conclusions The number of PLWHs with severe immunosuppression who seek treatment remains high in Shenzhen, China. Thus, current HIV‐related care programmes targeting access to early diagnosis and treatment need to be improved.

Risk Factors for Late HIV Presentation in Patients Treated at a Single Belgian Reference Centre from 2018 to 2022

“…We found that older patients and patients from sub-Saharan Africa were at risk of late presentation with advanced HIV disease. This could be explained by patients’ fear of the perceived consequences of a positive test result, notably the fear of stigma and discrimination [ 20 , 21 , 22 ]. Past adverse experiences such as loss of acquaintances during the early days of the HIV epidemic may also explain late testing and late presentation, especially among older patients [ 22 ].…”

The differential impacts of early detection and accelerated antiretroviral therapy on the epidemiologic trend of sexually acquired HIV infection in Hong Kong

“…Direct comparison of the percentage of late presenters between the two cohorts (at 57.6% and 59.0% respectively) did not show any statistically significant difference. The phenomenon of late presentation was observed in other parts of the world [ 15 , 19 ] and one possible reason could be the persistent lack of awareness and stigmatization [ 27 , 28 ]. In Hong Kong where a majority of newly diagnosed HIV infection were sexually acquired, the problem of late presentation was higher among heterosexuals compared to MSM.…”

Willingness to use long-acting injectable PrEP among HIV-negative/unknown men who have sex with men in mainland China: A cross-sectional online survey

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