Abstract
BackgroundThe aim of this study was to determine the proportions and predictors of late presentation (LP) and advanced HIV disease (AD) in Oman. LP and AD were defined as presenting with a baseline CD4 count of < 350 and < 200 cells/mm3, respectively.MethodsWe conducted a retrospective database analysis of the National HIV Surveillance System to identify Omani people (≥ 13 years old) who were diagnosed with HIV in the period between January 2000 and December 2019 and had a documented baseline CD4 cell count. We calculated the rates and trend over time of LP and AD. A logistic regression was carried out to determine the predictors of LP and AD.ResultsA total of 1418 patients, who were diagnosed with HIV in the period from January 2000 to December 2019, were included; 71% were male and 66% were heterosexuals. The median (IQR) age at diagnosis was 33 (25–39) years. Overall, 71% (95% CI: 68–73) and 46% (95% CI: 44–49) of patients had LP and AD at presentation, respectively. The LP percentage decreased from 76% in 2000–2004 to 69% in 2015–2019; AD percentage decreased from 57 to 46% over the same period. The proportions of men with LP and AD were higher than women (74% vs. 62 and 50% vs. 36%, respectively). The percentages of persons with LP among people aged 13–24, 25–49, and ≥ 50 years were 65, 71, and 84%, respectively. The proportions of persons with AD among people aged 13–24, 25–49, and ≥ 50 years were 39, 46, and 65%, respectively. Logistic regression showed that male sex, older age, having an “unknown” HIV risk factor, and living outside Muscat were independent predictors of AD. Male sex also independently predicted LP.ConclusionsThis analysis indicates that a significant proportion of new HIV cases in Oman continue to present late. This study identified patient subgroups at greatest risk of late HIV diagnosis such as men and older people. Targeted interventions and greater efforts to scale up HIV testing services in Oman are needed.
Highlights
The aim of this study was to determine the proportions and predictors of late presentation (LP) and advanced Human immunodeficiency (HIV) disease (AD) in Oman
Population We included Omani people (≥ 13 years old) who were diagnosed with HIV in the period from January 2000 to December 2019 and had a documented baseline CD4 cell count
The proportions of men with LP and advanced HIV disease (AD) were higher than women (74% vs. 62 and 50% vs. 36%, Table 1 Advanced HIV disease and late presentation in Oman, 2000–2019 (N = 1418)
Summary
The aim of this study was to determine the proportions and predictors of late presentation (LP) and advanced HIV disease (AD) in Oman. Individuals who know their HIV serostatus can modify their risk behaviours and access treatment, both of which can help reduce onward HIV transmission [3, 4]. Late presentation (LP) was defined as the presence of either an AIDS-related condition regardless of CD4 cell count or a CD4 count of < 350 cells/mm at presentation for care. Advanced HIV disease (AD) was defined as the presence of either an AIDS-related illness regardless of CD4 cell count or a CD4 count of < 200 cells/mm at presentation [6]. Late HIV diagnosis could be attributed to barriers to HIV testing related to policy, provider, and patient [7,8,9]. Punitive laws deter those most at risk of HIV, such as sex workers, men who sex with men (MSM) and people who inject drugs (PWID), from accessing HIV testing services [9]
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