Abstract
BackgroundAfter observing persistently low CD4 counts at initial HIV diagnosis in South Africa, we sought to determine risk factors for late-stage HIV disease presentation among adults.MethodsWe surveyed adults prior to HIV testing at four outpatient clinics in Durban from August 2010 to November 2011. All HIV-infected adults were offered CD4 testing, and late-stage HIV disease was defined as a CD4 count <100 cells/mm3. We used multivariate regression models to determine the effects of sex, emotional health, social support, distance from clinic, employment, perceived barriers to receiving healthcare, and foregoing healthcare to use money for food, clothing, or housing (“competing needs to healthcare”) on presentation with late-stage HIV disease.ResultsAmong 3,669 adults screened, 830 were enrolled, newly-diagnosed with HIV and obtained a CD4 result. Among those, 279 (33.6%) presented with late-stage HIV disease. In multivariate analyses, participants who lived ≥5 kilometers from the test site [adjusted odds ratio (AOR) 2.8, 95% CI 1.7–4.7], reported competing needs to healthcare (AOR 1.7, 95% CI 1.2–2.4), were male (AOR 1.7, 95% CI 1.2–2.3), worked outside the home (AOR 1.5, 95% CI 1.1–2.1), perceived health service delivery barriers (AOR 1.5, 95% CI 1.1–2.1), and/or had poor emotional health (AOR 1.4, 95% CI 1.0–1.9) had higher odds of late-stage HIV disease presentation.ConclusionsIndependent risk factors for late-stage HIV disease presentation were from diverse domains, including geographic, economic, demographic, social, and psychosocial. These findings can inform various interventions, such as mobile testing or financial assistance, to reduce the risk of presentation with late-stage HIV disease.
Highlights
South Africa has more HIV-infected people than any other country, and over 1.4 million South Africans are receiving antiretroviral therapy (ART) [1,2]
Most participants (79.7%) had never previously been tested for HIV, including 54 of the 60 participants (90.0%) who had spent an overnight in a hospital during the prior year
Reported HIV testing of participants hospitalized during the prior year (6/60 or 10.0%) was significantly lower than the reported HIV testing among participants who had not been hospitalized during the prior year (162/769 or 21.1%) (p = 0.04)
Summary
South Africa has more HIV-infected people than any other country, and over 1.4 million South Africans are receiving antiretroviral therapy (ART) [1,2]. Despite this progress, 45–51% of ART-eligible people are still not receiving treatment [1,3]. Do these HIV-infected people constitute nearly one-quarter of all AIDS-related deaths in sub-Saharan Africa, but they transmit HIV to others [1]. After observing persistently low CD4 counts at initial HIV diagnosis in South Africa, we sought to determine risk factors for late-stage HIV disease presentation among adults
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