Abstract
BackgroundEarly presentation for HIV care is vital as an initial tread in the UNAIDS 90–90–90 targets. However, late presentation for HIV care (LP) challenges achieving the targets. This study assessed the prevalence, trends, outcomes and risk factorsfor LP.MethodsA 12 year retrospective cohort study was conducted using electronic medical records extracted from an antiretroviral therapy (ART) clinic at Jimma University Teaching Hospital. LP for children refers to moderate or severe immune-suppression, or WHO clinical stage 3 or 4 at the time of first presentation to the ART clinics. LP for adults refers to CD4 lymphocyte count of < 200 cells/ μl and < 350 cells/μl irrespective of clinical staging, or WHO clinical stage 3 or 4 irrespective of CD4 count at the time of first presentation to the ART clinics. Binary logistic regression was used to identify factors that were associated with LP, and missing data were handled using multiple imputations.ResultsThree hundred ninety-nine children and 4900 adults were enrolled in ART care between 2003 and 15. The prevalence of LP was 57% in children and 66.7% in adults with an overall prevalence of 65.5%, and the 10-year analysis of LP showed upward trends. 57% of dead children, 32% of discontinued children, and 97% of children with immunological failure were late presenters for HIV care. Similarly, 65% of dead adults, 65% of discontinued adults, and 79% of adults with immunological failure presented late for the care. Age between 25- < 50 years (AOR = 0.4,95% CI:0.3–0.6) and 50+ years (AOR = 0.4,95% CI:0.2–0.6), being female (AOR = 1.2, 95% CI: 1.03–1.5), having Tb/HIV co-infection (AOR = 1.6, 95% CI: 1.09–2.1), having no previous history of HIV testing (AOR = 1.2, 95% CI: 1.1–1.4), and HIV care enrollment period in 2012 and after (AOR = 0.8, 95% CI: 0.7–0.9) were the factors associated with LP for Adults. For children, none of the factors were associated with LP.ConclusionsThe prevalence of LP was high in both adults and children. The majority of both children and adults who presented late for HIV care had died and developed immunological failure. Effective programs should be designed and implemented to tackle the gap in timely HIV care engagement.
Highlights
Presentation for Human immunodeficiency virus (HIV) care is vital as an initial tread in the United Nations Program on HIV and AIDS (UNAIDS) 90–90–90 targets
This paper examines the prevalence, trend, outcomes and risk factors of Late presentation for HIV care (LP) among children and adults enrolled for antiretroviral therapy (ART) in Jimma University Teaching Hospital (JUTH), Southwest Ethiopia
Of the 8172 patients enrolled for HIV care between 21 June 2003 and 15 March 2015, 5299 (64.8%) patients on ART, the study population for the study, were included
Summary
Presentation for HIV care is vital as an initial tread in the UNAIDS 90–90–90 targets. Late presentation for HIV care (LP) challenges achieving the targets. While diagnosing HIV infection is vital as the initial tread in the 90–9090 targets, diagnosis per se is no longer sufficient [2]. Diagnosis and access to treatment helps people with HIV to timely get and appropriately use HIV treatment [3] that further reduces the virus load and risk of morbidity and mortality. Late presentation for HIV care (LP) has been recognized as an impediment to meet the above mentioned UNAIDS targets. The definition of LP is disparate and is contextualized using the threshold for ART eligibility [5]. Numerous definitions have been used including: i) when the baseline CD4 count is < 200 or < 350 cells/μl and/or with an AIDS defining disease [3, 6, 7], ii) when AIDS defining conditions are diagnosed either before or during the period to an HIV diagnosis [8], iii) when AIDS defining conditions are diagnosed in the subsequent 6 months period to an HIV diagnosis [9], or iv) when AIDS defining conditions are diagnosed 12 months period to an HIV diagnosis [10]
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