Socio-demographic and clinical determinants of late presentation among patients newly diagnosed with HIV in the Eastern Cape, South Africa

Abstract

South Africa recently implemented the ‘test and treat’ strategy for all HIV-infected individuals receiving diagnosis at the health facility level. However, the impact of this programme in terms of the prevention of HIV transmission, morbidity and mortality associated with HIV can only be maximized if patients are diagnosed early. This study determines the prevalence of late presentation among newly diagnosed HIV-infected individuals and also examines the socio-demographic and clinical determinants for late presentation in health facilities in the Eastern Cape Province, South Africa. In this cross-sectional study, a total of 335 newly diagnosed patients were recruited consecutively between August 2016 and July 2017. Late presenter for HIV care was defined in accordance with the European Late Presenter Consensus working group as a patient who reports for care when the CD4 count is below 350 cells/μL and/or when there is an established AIDS-defining clinical condition, irrespective of CD4 count. Adjusted and unadjusted logistic regression analysis was used to examine the determinants of late HIV diagnosis. Participants’ mean age was 33.6 (SD: 10.6). Almost 96% of the participants believed their route of HIV infection was heterosexual sex. Most newly diagnosed HIV-infected patients (60%) were late presenters (CD4+ count ≤350 cells/μL and/or having an AIDS-defining illness in World Health Organisation (WHO)-defined stage III/IV), with 35% presenting with Acquired Immune Deficiency Syndrome (AIDS)-related complications. In the adjusted model, only male sex (AOR: 2.81; CI: 1.51–5.23), no formal education (AOR: 5.63; CI: 1.68–18.85), and overweight body mass category (AOR: 2.45; CI: 1.04–5.75) were independently associated with late HIV diagnosis. The majority of newly diagnosed HIV-infected individuals were late presenters. To maximize the impact of the ‘test and treat’ policy aimed at reducing new HIV transmissions and preventing the morbidity and mortality associated with HIV, there is a need for programmes to improve early detection of HIV in the study settings. This programme should target males and individuals with no formal education for maximum impact.

Low coverage of HIV testing among adolescents and young adults in Nigeria: Implication for achieving the UNAIDS first 95

“…Late diagnosis and poor adherence to ART and retention in care are among the main reasons for poor treatment outcomes in this age cohort. There is evidence that less than a quarter of young adults in sub-Saharan Africa have ever tested for HIV, and the rate is even much lower among young men, and for those who are HIV+, the testing is usually performed late [3][4][5][6]. Early diagnosis of HIV is a critical first step to initiating ART, preventing new HIV infections and AIDS-related deaths, and ensuring good quality of life and wellbeing for young people potentially living with HIV [1].…”

Diagnosing Diabetes Mellitus With Glycated Haemoglobin in Newly Diagnosed HIV-positive Patients in Buffalo City Municipality, South Africa: A Cross-sectional Study

“…The International Society for the Advancement of Kinanthropometry protocol [18] was used to measure the weight and height of the participants. Body weight was measured in light clothing without shoes using a calibrated digital electronic weighing scale (Seca 813, Seca, UK) to the nearest 0.1 kilogram.…”

HIV testing and self‐testing coverage among men and women in South Africa: an exploration of related factors

“…HIV testing is a prerequisite for early diagnosis, providing treatment and support for individuals diagnosed with HIV and ultimately averting new infections and AIDS‐related deaths [4, 6]. However, despite the benefits of HIV testing, many individuals have never tested for HIV [8–12], and some individuals newly diagnosed present with late‐stages disease [13]. Undiagnosed individuals are at increased risk of transmitting the virus to others [14] and account for 38% of new transmissions [15, 16].…”

“…Gaps in HIV testing are among the main reasons driving the new HIV transmissions. A study shows that the vast majority of newly diagnosed people with HIV in the country presented with late‐stage disease, meaning that they tested late and may have transmitted the virus [13]. Thus, closing gaps in HIV testing is critical to accelerate progress, improve outcomes and maximise the benefits of the ‘universal test and treat’ policy of the country.…”