Unmatched Case-Control Study on Late Presentation of HIV Infection in Santiago, Cape Verde (2004–2011)

Abstract

Access to free antiretroviral therapy (ART) in Sub-Saharan Africa has been steadily increasing over the past decade. However, the success of large-scale ART programmes depends on timely diagnosis and early initiation of HIV care. This study characterizes late presenters to HIV care in Santiago (Cape Verde) between 2004 and 2011, and identifies factors associated with late presentation for care. We defined late presentation as persons presenting to HIV care with a CD4 count below 350 cells/mm3. An unmatched case-control study was conducted using socio-demographic and behavioural data of 368 individuals (191 cases and 177 controls) collected through an interviewer-administered questionnaire, comparing HIV patients late and early presented to care. Logistic regression was performed to estimate odds ratio and 95% confidence intervals. Results show that 51.9% were late presenters for HIV. No differences were found in gender distribution, marital status, or access to health services between cases and controls. Participants who undertook an HIV test by doctor indication were more likely to present late compared with those who tested for HIV by their own initiative. Also, individuals taking less time to initiate ART are more likely to present late. This study highlights the need to better understand reasons for late presentation to HIV care in Cape Verde. People in older age groups should be targeted in future approaches focused on late presenters to HIV care.

Frequency and reasons for delayed treatment initiation after HIV diagnosis: cross-sectional study in Lahore, Pakistan

“…In addition, a bivariate logistic regression was performed using a backward stepwise technique to establish the variables related to delayed HIV treatment. Factors that were significant at p < 0.20 were considered for the multivariate model [ 19 ]. The strengths of association were evaluated for factors related to late commencement of ART by means of adjusted odds ratios (AORs) with 95% confidence intervals (CIs).…”

Risk factors for late linkage to care and delayed antiretroviral therapy initiation among adults with HIV in sub-Saharan Africa: a systematic review and meta-analyses

“…In most studies, the rate of linkage to care was determined based on the time since diagnosis (Reddy et al, 2016;Takah et al, 2016;Billioux et al, 2017;Cholera et al, 2017;Dorward et al, 2017;Franse et al, 2017;Kulkarni et al, 2017;Sanga et al, 2017;Teklu et al, 2017;Boeke et al, 2018;Kayabu et al, 2018;Lopez-Varela et al, 2018;Rane et al, 2018;Rentsch et al, 2018;Maughan-Brown et al, 2019;Hoffman et al, 2020;Maughan-Brown et al, 2021), and late presentation for care was defined as engagement in care at CD4 count <350cells/mm 3 and/or WHO clinical stage III/IV (Gelaw et al, 2015;Haskew et al, 2015;Moreira et al, 2016;Gesesew et al, 2018;Luma et al, 2018). Five studies considered care engagement at CD4 count <200cells/mm 3 as late linkage to care (Honge et al, 2016;Nyika et al, 2016;van der Kop et al, 2016;Gesesew et al, 2018;Lifson et al, 2019) and one study at CD4 count ≤100 cells/mm 3 (Kwobah et al, 2016).…”

“…Fifteen studies reported associations between perceptual or psychosocial factors and late linkage to care (Gelaw et al, 2015;Moreira et al, 2016;Nyika et al, 2016;Reddy et al, 2016;Dorward et al, 2017;Kulkarni et al, 2017;Maheu-Giroux et al, 2017;Sanga et al, 2017;Gesesew et al, 2018;Lopez-Varela et al, 2018;Luma et al, 2018;Rane et al, 2018;Maughan-Brown et al, 2019;Hoffman et al, 2020;Maughan-Brown et al, 2021).…”

“…Testing because of illness (Moreira et al, 2016;Nyika et al, 2016;Reddy et al, 2016;Sanga et al, 2017;Luma et al, 2018), having a previous history of HIV diagnosis (Maheu-Giroux et al, 2017;Gesesew et al, 2018;Lopez-Varela et al, 2018), readiness for treatment (Maughan-Brown et al, 2019), holding a positive-outcome belief in care and using positive reframing as a coping strategy (Hoffman et al, 2020) increased the likelihood of linkage to care. Nondisclosure of HIV status (Gelaw et al, 2015;Dorward et al, 2017;Sanga et al, 2017;Maughan-Brown et al, 2019;Hoffman et al, 2020;Maughan-Brown et al, 2021), a desire for repeated testing (Kulkarni et al, 2017;Maughan-Brown et al, 2021), an experience or fear of stigma (Gelaw et al, 2015;Nyika et al, 2016;Maughan-Brown et al, 2019), having low household social support (Gelaw et al, 2015) and having severe depression and anxiety (Rane et al, 2018) increased delays in care linkage.…”

“…;Sanga et al, 2017;Teklu et al, 2017;Boeke et al, 2018;Bor et al, 2018;Gebru et al, 2018;Gesesew et al, 2018;Lopez-Varela et al, 2018;Luma et al, 2018;Ngom et al, 2018;Rane et al, 2018;Katz et al, 2019;Onoya et al, 2020) while 19 studies employed a cross-sectional design(Haskew et al, 2015;Boyer et al, 2016;Kwobah et al, 2016;Nash et al, 2016;Takah et al, 2016;van der Kop et al, 2016;Cholera et al, 2017;Fomundam et al, 2017;Franse et al, 2017;Hoffman et al, 2017;Kulkarni et al, 2017;Kayabu et al, 2018;Anlay et al, 2019;Larsen et al, 2019;Lifson et al, 2019;Maughan-Brown et al, 2019;Esber et al, 2020;Lilian et al, 2020;Maughan-Brown et al, 2021). The remaining three studies employed a case-control design(Gelaw et al, 2015;Moreira et al, 2016;Nyika et al, 2016). Twenty-one studies reported on linkage to HIV care(Gelaw et al, 2015;Haskew et al, 2015;Honge et al, 2016;Kwobah et al, 2016;Moreira et al, 2016;Nyika et al, 2016;Reddy et al, 2016;Takah et al, 2016;van der Kop e...…”