Prevalence and predictors of late presentation for HIV care in South Africa

Abstract

Background Many people living with HIV in South Africa (SA) are not aware of their seropositive status and are diagnosed late during the course of HIV infection. These individuals do not obtain the full benefit from available HIV care and treatment services. Objectives To describe the prevalence of late presentation for HIV care among newly diagnosed HIV-positive individuals and evaluate sociodemographic variables associated with late presentation for HIV care in three high-burden districts of SA. Methods We used data abstracted from records of 8 138 newly diagnosed HIV-positive individuals in 35 clinics between 1 June 2014 and 31 March 2015 to determine the prevalence of late presentation among newly diagnosed HIV-positive individuals in selected high-prevalence health districts. Individuals were categorised as ‘moderately late’, ‘very late’ or ‘extremely late’ presenters based on specified criteria. Descriptive analysis was performed to measure the prevalence of late presentation, and multivariate regression analysis was conducted to identify variables independently associated with extremely late presentation. Results Overall, 79% of the newly diagnosed cases presented for HIV care late in the course of HIV infection (CD4+ count ≤500 cells/ μL and/or AIDS-defining illness in World Health Organization (WHO) stage III/IV), 19% presented moderately late (CD4+ count 351 – 500 cells/μL and WHO clinical stage I or II), 27% presented very late (CD4+ count 201 – 350 cells/μL or WHO clinical stage III), and 33% presented extremely late (CD4+ count ≤200 cells/μL and/or WHO clinical stage IV) for HIV care. Multivariate regression analysis indicated that males, non-pregnant women, individuals aged >30 years, and those accessing care in facilities located in townships and inner cities were more likely to present late for HIV care. Conclusions The majority of newly diagnosed HIV-positive individuals in the three high-burden districts (Gert Sibande, uThukela and City of Johannesburg) presented for HIV care late in the course of HIV infection. Interventions that encourage early presentation for HIV care should be prioritised in SA and should target males, non-pregnant women, individuals aged >30 years and those accessing care in facilities located in inner cities and urban townships.

Screening for invasive fungal disease using non‐culture‐based assays among inpatients with advanced HIV disease at a large academic hospital in South Africa

“…In an observational study in a Western Cape hospital from 2012 through to 2013, 64% of newly diagnosed and known HIV‐seropositive patients had a baseline CD4+ T‐lymphocyte (CD4) count below 200 cells/µL (median CD4 count of 134 cells/µL) 2 . Worldwide, between 31% and 77% of HIV‐seropositive persons seek health care for the first time with advanced HIV 3‐6 . However, in South Africa, an increasing proportion of persons with advanced immunosuppression are ART‐experienced and seek hospital care following virological failure or treatment interruption 2,7 …”

Identifying and predicting longitudinal trajectories of care for people newly diagnosed with HIV in South Africa

“…Our demographic findings about people presenting with advanced HIV are largely similar to those in other studies in sub-Saharan Africa. In a study of over 12,000 patients newly diagnosed with HIV in South Africa, risk factors for late presentation (CD4 <200) included older age and male sex [22]. A study in Mbarara, Uganda found that older age, male gender, lower education, unemployment, and distance from clinic were all risk factors for late presentation [23].…”

“…Employment has been observed as a facilitator for care engagement in some settings, and a risk factor for late presentation and delayed ART in others [21,26,27]. Some studies have found that care in urban setting is associated with worse HIV outcomes, while others have found distance from clinic a risk factor for poor outcomes [21][22][23]. Some studies have found alcohol use a risk factor for late presentation while others found it predictive of earlier presentation [23,28].…”

“…While this loss is large, it is consistent with other studies. In a study of over 12,000 patients newly diagnosed with HIV in South Africa, over a third did not have a single CD4 count measured [22]. In a systematic review of retention in care in sub-Saharan Africa, one-to two-thirds of patients are lost from care between HIV diagnosis and CD4 count measurement, and approximately one third of patients with a CD4 count were lost to care prior to starting ART [7].…”

Socio-demographic, clinical and health facility-related predictors of delayed HIV diagnosis among patients newly diagnosed with HIV in Northwest Ethiopia: a multilevel analysis

“…Early initiation of ART will decrease disease progression and mortality and enhance HIV prevention [7][8][9]. However, HIV infected people delayed seeking health care and delay in initiating ART in East Africa is quite common [10][11][12]. The situation is similar in Ethiopia in which HIV infected people present to care and treatment within advanced disease stages [13][14][15].…”