Trends of late HIV presentation and advance HIV disease among newly diagnosed HIV cases in Jiangsu, China: A serial cross-sectional study from 2008 to 2020

Abstract

BackgroundThis study aimed to assess the trends and determine the factors associated with late presentation (LP) and advanced HIV disease (AHD) among newly diagnosed people living with HIV (PLWH) from 2008 to 2020 in Jiangsu, China.MethodsNewly diagnosed PLWH registered in the HIV surveillance system from 2008 to 2020 were included. Multivariable logistic regression models were used to analyze the factors associated with LP and AHD. The LP and AHD trends were assessed using Joint-point analysis.ResultsOf 37,251 newly diagnosed PLWH identified, 30,251(81.2%) patients met the inclusion criteria. Among those, 16,672 (55.1%) were considered LP, and 8,691 (28.7%) had AHD. LP trends steadily increased from 2008 (39.0%) to 2020 (59.4%), but AHD trends decreased visibly from 2016 (32.3%) to 2020 (23.4%). The overall median CD4 trends decreased slowly from 389 to 305 cells/mm3 between 2008 and 2020. Married patients and those older than 35 years were more likely to be LP and have AHD. Patients infected via heterosexual transmission had a higher risk of being classified as AHD (aOR: 1.13, 95%CI: 1.06–1.21) than patients infected via homosexual transmission. Patients that were diagnosed at sexually transmitted infections (STIs) clinics (aOR: 1.10, 95%CI: 1.01–1.20) and in hospitals (aOR: 1.69, 95%CI: 1.59–1.79) were more likely to be classified as LP compared with patients diagnosed at voluntary counseling and testing (VCT) centers. Similar, patients diagnosed at STIs clinics (aOR: 1.23, 95%CI: 1.11–1.36) and hospitals (aOR: 2.27, 95%CI: 2.12–2.43) were more likely to have AHD than patients diagnosed in VCT.ConclusionOur findings indicate an alarming burden of LP in Jiangsu, suggesting the need for more attention toward HIV diagnosis at early CD4 stages. National HIV control programs must strengthen comprehensive interventions for HIV prevention and promote HIV services. Also, strategies for HIV prevention (PrEP and PEP), testing, and treatment must be extended, especially among the general population.

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

“…Other studies performed during a similar timeframe (2017 to 2020, 2019 to 2020 and 2015 to 2020) also revealed that male and older patients are at greater risk of late HIV presentation [ 23 , 24 , 25 ]. Additionally, other LP risk factors, including bisexual transmission, heterosexual transmission, being married, SSA origin, tuberculosis or hepatitis C virus coinfection, lower socioeconomic status and the fear of stigma, have been reported in various studies [ 25 , 26 , 27 , 28 , 29 , 30 , 31 , 32 , 33 ]. The discrepancies observed among those studies highlight the importance of identifying populations at risk of late presentation and developing specific guidelines according to the region.…”

Health Seeking Behavior to the Development of Public Policy for HIV Predicting Model

“…Understanding health-seeking and health maintenance behaviors is pivotal for the control and treatment of HIV. A significant number of patients show delayed healthcare-seeking patterns, leading to a higher risk of community transmission (Shi et al, 2020). The current healthcare policies, infrastructure, and socio-demographic profile of HIV patients contribute to the complexity of improving health-seeking behaviors and adherence to treatment (Chirambo et al, 2019).…”

Changes Over Time in the Proportion of Advanced HIV Disease in Two High HIV Prevalence Settings in Ndhiwa (Kenya) and Eshowe (South Africa)

“…7 Published data showed varying differences in changes in the proportion of advanced HIV disease among people presenting for care at clinics in South Africa with some little or no change 8 , 9 while others reported substantial decline over the years. 10 - 12 A larger proportion of people with advanced HIV are ART experienced 2 suggesting that the majority of these seek care late when their health has already deteriorated although the proportion of late presenters and those initiating ART with advanced HIV is slowly decreasing 11 , 13 with mixed results in others. 12 …”

“… 10 - 12 A larger proportion of people with advanced HIV are ART experienced 2 suggesting that the majority of these seek care late when their health has already deteriorated although the proportion of late presenters and those initiating ART with advanced HIV is slowly decreasing 11 , 13 with mixed results in others. 12 …”