Late Presentation into Care of HIV Disease and Its Associated Factors in Asia: Results of TAHOD

Abstract

Many HIV-infected individuals do not enter health care until late in the infection course. Despite encouraging earlier testing, this situation has continued for several years. We investigated the prevalence of late presenters and factors associated with late presentation among HIV-infected patients in an Asian regional cohort. This cohort study included HIV-infected patients with their first positive HIV test during 2003-2012 and CD4 count and clinical status data within 3 months of that test. Factors associated with late presentation into care (CD4 count <200 cells/μl or an AIDS-defining event within ±3 months of first positive HIV test) were analyzed in a random effects logistic regression model. Among 3,744 patients, 2,681 (72%) were late presenters. In the multivariable model, older patients were more likely to be late presenters than younger (≤30 years) patients [31-40, 41-50, and ≥51 years: odds ratio (OR) = 1.57, 95% confidence interval (CI) 1.31-1.88; OR = 2.01, 95% CI 1.58-2.56; and OR = 1.69, 95% CI 1.23-2.31, respectively; all p ≤ 0.001]. Injecting drug users (IDU) were more likely (OR = 2.15, 95% CI 1.42-3.27, p < 0.001) and those with homosexual HIV exposure were less likely (OR = 0.45, 95% CI 0.35-0.58, p < 0.001) to be late presenters compared to those with heterosexual HIV exposure. Females were less likely to be late presenters (OR = 0.44, 95% CI 0.36-0.53, p < 0.001). The year of first positive HIV test was not associated with late presentation. Efforts to reduce the patients who first seek HIV care at the late stage are needed. The identified risk factors associated with late presentation should be utilized in formulating targeted public health intervention to improve earlier entry into HIV care.

Late Presentation to Care among People Living with HIV in Cotonou, Benin: A Retrospective Analysis from 2003 to 2014

“…Similar results were also found by Jeong et al [20]. The reason is that the screening campaigns that were carried out targeted mainly young people and offered very little opportunities for old people to be screened early.…”

The prevalence and associated factors for delayed presentation for HIV care among tuberculosis/HIV co-infected patients in Southwest Ethiopia: a retrospective observational cohort

“…In Europe for example, the prevalence of DP has been reported to be roughly between 15 and 66 % [18, 19]. Higher prevalence of 72–83.3 % [20, 21] has been reported from Asia. In Africa, 35–65 % report late for HIV care [22–25].…”

“…In Africa, 35–65 % report late for HIV care [22–25]. Reported barriers to DP among general population have include several factors including: age, sex, level of education, income, place of residence, perceiving HIV as curable, HIV related stigma, co-morbidity, having contact with female sex workers, alcohol users, chewing chat, smoking cigarette, perceived risky sexual behaviour, pre-and post-test counseling [4, 15, 20, 21, 26, 27]. …”

What are the factors associated with human immunodeficiency virus/sexually transmitted infection screening behaviour among heterosexual men patronising entertainment establishments who engaged in casual or paid sex? – Results from a cross-sectional survey in an Asian urban setting

“…Majority of the HIV infections in the United States (US) is via homosexual transmission [3] in contrast to Asia where heterosexual transmission predominates [4]. Late presentation of HIV is associated with heterosexual transmission, particularly among heterosexual males in Asia [5]. Late presentation is detrimental to both the infected person and the community’s HIV response.…”