Abstract
BackgroundWe surveyed HIV patients with late-stage disease in southern Vietnam to determine if barriers to access and service quality resulted in late HIV testing and delays from initial diagnosis to entry into HIV care.Methodology196 adult patients at public HIV clinics with CD4 counts less than 250 cells/mm3 completed a standardized questionnaire. We used multivariate analysis to determine risk factors for delayed entry into care, defined as >3 months time from diagnosis to registration.ResultsCommon reasons for delayed testing were feeling healthy (71%), fear of stigma and discrimination in the community (43%), time conflicts with work or school (31%), did not want to know if infected (30%), and fear of lack of confidentiality (27%). Forty-five percent of participants delayed entry into care with a median CD4 count of 65 cells/mm3. The most common reasons for delayed entry were feeling healthy (51%), fear of stigma and discrimination in the community (41%), time conflicts with work or school (33%), and fear of lack of confidentiality (26%). Independent predictors for delayed entry were feeling healthy (aOR 3.7, 95% CI 1.5–9.1), first positive HIV test at other site (aOR 2.9, CI 1.2–7.1), history of injection drug use (IDU) (aOR 2.9, 95% CI 1.1–7.9), work/school conflicts (aOR 4.3, 95% CI 1.7–10.8), prior registration at another clinic (aOR 77.4, 95% CI 8.6–697), detention or imprisonment (aOR 10.3, 95% CI 1.8–58.2), and perceived distance to clinic (aOR 3.7, 95% CI 1.0–13.7).ConclusionDelayed entry into HIV care in Vietnam is common and poses a significant challenge to preventing AIDS and opportunistic infections, decreasing mortality, and reducing HIV transmission. Improved linkages between testing and care are needed, particularly for patients who feel healthy, as well as incarcerated and drug-using populations who may face structural and social barriers to accessing care.
Highlights
Delays between HIV diagnosis and registering for care may lead to late antiretroviral treatment (ART) initiation and increased morbidity and mortality
Survey Design, Sites and Population In Vietnam, HIV testing is available through stand-alone clinics or co-located with a network of 318 free public HIV outpatient clinics (OPCs) across the country
All People living with HIV (PLHIV) with CD4 count, 350 or WHO clinical stage III/IV conditions are eligible for ART
Summary
Delays between HIV diagnosis and registering for care may lead to late antiretroviral treatment (ART) initiation and increased morbidity and mortality. The impact of immune restoration has been clearly demonstrated in cohort studies and randomized clinical trials that have shown decreased mortality and morbidity, including AIDS defining clinical events and tuberculosis, with initiation of ART at higher CD4 counts [1,4,5,6,7,8,9,10,11,12]. Enrolment into care and ART for these populations can significantly reduce HIV transmission as part of a combined prevention strategy [4,13,14,15,16,17]. As larger segments of the HIV-infected population are enrolled and started on ART, transmission of HIV within the at-risk community can be significantly reduced [18,19]. We surveyed HIV patients with late-stage disease in southern Vietnam to determine if barriers to access and service quality resulted in late HIV testing and delays from initial diagnosis to entry into HIV care
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