Abstract
BackgroundAccess to free antiretroviral therapy in Sub-Saharan Africa has been steadily increasing. The success of large-scale antiretroviral therapy programs depends on early initiation of HIV/AIDs care. The purpose of the study was to examine factors associated with late presentation to HIV/AIDS care.MethodsA case-control study was conducted in Dessie referral and Borumeda district hospitals from March 1 to 31, 2010, northern Ethiopia. A total of 320 study participants (160 cases and 160 controls) were included in the study. Cases were people living with HIV/AIDS (PLHA) who had a WHO clinical stage of III or IV or a CD4 lymphocyte count of less than 200/uL at the time of the first presentation to antiretroviral treatment (ART) clinics. Controls were PLHA who had WHO stage I or II or a CD4 lymphocyte count of 200/uL or more irrespective of clinical staging at the time of first presentation to the ART clinics of the hospitals cases and controls were interviewed by trained nurses using a pre-tested and structured questionnaire. In-depth interviews were conducted with ten health workers and eight PLHA.ResultsPLHA who live with their families [OR = 3.29, 95%CI: 1.28-8.45)], lived in a rented house [OR = 2.52, 95%CI: 1.09-5.79], non-pregnant women [OR = 9.3, 95% CI: 1.93-44.82], who perceived ART have many side effects [OR = 6.23, 95%CI:1.63,23.82)], who perceived HIV as stigmatizing disease [OR = 3.1, 95% CI: 1.09-8.76], who tested with sickness/symptoms [OR = 2.62, 95% CI: 1.26-5.44], who did not disclose their HIV status for their partner [OR = 2.78, 95% CI: 1.02-7.56], frequent alcohol users [OR = 3.55, 95% CI: 1.63-7.71] and who spent more than 120 months with partner at HIV diagnosis[OR = 5.86, 95% CI: 1.35-25.41] were significantly associated with late presentation to HIV/AIDS care. The qualitative finding revealed low awareness, non-disclosure, perceived ART side effects and HIV stigma were the major barriers for late presentation to HIV/AIDS care.ConclusionsEfforts to increase early initiation of HIV/AIDS care should focus on addressing patient's concerns such as stigma, drug side effects and disclosure.
Highlights
Sub-Saharan Africa remains the most affected region in the global AIDS epidemic; with an estimated 22.5 million people living with HIV [1]
Variables which showed association with late presentation to HIV/AIDS care in the bivariate analysis such as occupational status at HIV diagnosis, area of residence, marital status, living arrangements, ownership of residence, pregnancy status, understanding all HIV positive are eligible to HIV/AIDS care, perceiving ART have many side effects, HIV stigma, awareness of voluntary counseling and testing (VCT), source of information about VCT, knowing where to get VCT, HIV testing with symptoms/sickness, HIV testing with medical consultation, HIV status disclosure to partner, HIV status disclosure to families, ever alcohol use, alcohol use in the previous year, having steady partner at HIV diagnosis, time spent with steady partner, health-seeking behaviour when felt at risk, prior experience of health system and travel time to hospital were further evaluated in the multivariable model
Living arrangement, ownership residence, pregnancy status, perceived ART side effects, perceived HIV stigma, symptoms at HIV diagnosis, HIV status disclosure to partner, ever alcohol use and time spent with steady partner were found to be independent factors of late presentation to HIV/AIDS care (Table 1)
Summary
Sub-Saharan Africa remains the most affected region in the global AIDS epidemic; with an estimated 22.5 million people living with HIV [1]. The health status of HIV positive individuals at the time of antiretroviral (ART) initiation plays a crucial role in the success of treatment [2,3,4,5,6]. HIV positive individuals with advanced HIV disease at the time of ART initiation are less likely to respond to treatment, are more likely to. Late presentation prevents people living with HIV/ AIDS from obtaining the maximal benefit of being screened for tuberculosis and sexually transmitted infections, receiving timely antiretroviral therapy, and benefiting from educational and prophylactic interventions that are more effective when implemented earlier and that can prevent further infections [5]. The purpose of the study was to examine factors associated with late presentation to HIV/AIDS care
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