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Advanced HIV disease at presentation to care in Nairobi, Kenya: late diagnosis or delayed linkage to care?--a cross-sectional study.

van der Kop ML, Thabane L, Awiti PO, Muhula S, Kyomuhangi LB, Lester RT, Ekström AM - BMC Infect. Dis. (2016)

Bottom Line: The objectives of this cross-sectional study were to determine factors associated with advanced HIV at presentation to care and whether this was due to late diagnosis or delays in accessing care.The median time to presentation to HIV care after an initial diagnosis was 22 days (IQR 6-147) for those with advanced HIV, compared to 19 days (IQR 4-119) for those with non-advanced HIV (p = 0.716).Clinic (adjusted odds ratio [AOR] 1.55, 95 % CI 1.09-2.20) and age (AOR 1.72 per unit increase in age category, 95 % CI 1.45-2.03) were associated with presenting with advanced HIV.

View Article: PubMed Central - PubMed

Affiliation: Department of Public Health Sciences/Global Health (IHCAR), Karolinska Institutet, Widerströmska Huset, Tomtebodavägen 18A, Stockholm, 171-77, Sweden. miavanderkop@gmail.com.

ABSTRACT

Background: Presenting to care with advanced HIV is common in sub-Saharan Africa and increases the risk of severe disease and death; however, it remains unclear whether this is a consequence of late diagnosis or a delay in seeking care after diagnosis. The objectives of this cross-sectional study were to determine factors associated with advanced HIV at presentation to care and whether this was due to late diagnosis or delays in accessing care.

Methods: Between 2013 and 2015, adults presenting to care were recruited at two clinics in low-income areas of Nairobi, Kenya. Participants were considered to have advanced HIV if their CD4 count was below 200 cells/μL, or they were in WHO stage 4. Information on previous HIV diagnoses was collected using interviewer-administered questionnaires. Logistic regression was used to determine the association between clinical and socio-demographic factors and advanced HIV.

Results: Of 753 participants presenting to HIV care, 248 (33 %) had advanced HIV. Almost 60 % (146/248) of those presenting with advanced HIV had been previously diagnosed, most of whom (102/145; 70 %) presented to care within three months of their initial diagnosis. The median time to presentation to HIV care after an initial diagnosis was 22 days (IQR 6-147) for those with advanced HIV, compared to 19 days (IQR 4-119) for those with non-advanced HIV (p = 0.716). Clinic (adjusted odds ratio [AOR] 1.55, 95 % CI 1.09-2.20) and age (AOR 1.72 per unit increase in age category, 95 % CI 1.45-2.03) were associated with presenting with advanced HIV.

Conclusions: Presentation to care with advanced HIV was primarily due to delayed diagnosis, rather than delayed linkage to care after diagnosis. Variation by clinic suggests that outreach and other community-based efforts may drive earlier testing and linkage to care. Our findings highlight the ongoing importance of implementing strategies to encourage earlier HIV diagnosis, particularly among adults 30 years and older.

No MeSH data available.


Related in: MedlinePlus

Participant recruitment flow diagram
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Fig1: Participant recruitment flow diagram

Mentions: Between April 2013 and June 2015, 1068 HIV-positive individuals presenting to the Baba Dogo and Kibera Health Centres were screened for study participation, and 775 were recruited (Fig. 1). The most frequent reasons patients were ineligible to participate were previous enrolment in HIV care (n = 160/262; 61 %) and pregnancy (n = 88/262; 34 %). Less than 3 % of screened participants (n = 31/1068) declined participation. Of the 775 participants recruited, baseline CD4 data were available for 97.2 % (n = 753/775) of the cohort.Fig. 1


Advanced HIV disease at presentation to care in Nairobi, Kenya: late diagnosis or delayed linkage to care?--a cross-sectional study.

van der Kop ML, Thabane L, Awiti PO, Muhula S, Kyomuhangi LB, Lester RT, Ekström AM - BMC Infect. Dis. (2016)

Participant recruitment flow diagram
© Copyright Policy - OpenAccess
Related In: Results  -  Collection

License 1 - License 2
Show All Figures
getmorefigures.php?uid=PMC4835937&req=5

Fig1: Participant recruitment flow diagram
Mentions: Between April 2013 and June 2015, 1068 HIV-positive individuals presenting to the Baba Dogo and Kibera Health Centres were screened for study participation, and 775 were recruited (Fig. 1). The most frequent reasons patients were ineligible to participate were previous enrolment in HIV care (n = 160/262; 61 %) and pregnancy (n = 88/262; 34 %). Less than 3 % of screened participants (n = 31/1068) declined participation. Of the 775 participants recruited, baseline CD4 data were available for 97.2 % (n = 753/775) of the cohort.Fig. 1

Bottom Line: The objectives of this cross-sectional study were to determine factors associated with advanced HIV at presentation to care and whether this was due to late diagnosis or delays in accessing care.The median time to presentation to HIV care after an initial diagnosis was 22 days (IQR 6-147) for those with advanced HIV, compared to 19 days (IQR 4-119) for those with non-advanced HIV (p = 0.716).Clinic (adjusted odds ratio [AOR] 1.55, 95 % CI 1.09-2.20) and age (AOR 1.72 per unit increase in age category, 95 % CI 1.45-2.03) were associated with presenting with advanced HIV.

View Article: PubMed Central - PubMed

Affiliation: Department of Public Health Sciences/Global Health (IHCAR), Karolinska Institutet, Widerströmska Huset, Tomtebodavägen 18A, Stockholm, 171-77, Sweden. miavanderkop@gmail.com.

ABSTRACT

Background: Presenting to care with advanced HIV is common in sub-Saharan Africa and increases the risk of severe disease and death; however, it remains unclear whether this is a consequence of late diagnosis or a delay in seeking care after diagnosis. The objectives of this cross-sectional study were to determine factors associated with advanced HIV at presentation to care and whether this was due to late diagnosis or delays in accessing care.

Methods: Between 2013 and 2015, adults presenting to care were recruited at two clinics in low-income areas of Nairobi, Kenya. Participants were considered to have advanced HIV if their CD4 count was below 200 cells/μL, or they were in WHO stage 4. Information on previous HIV diagnoses was collected using interviewer-administered questionnaires. Logistic regression was used to determine the association between clinical and socio-demographic factors and advanced HIV.

Results: Of 753 participants presenting to HIV care, 248 (33 %) had advanced HIV. Almost 60 % (146/248) of those presenting with advanced HIV had been previously diagnosed, most of whom (102/145; 70 %) presented to care within three months of their initial diagnosis. The median time to presentation to HIV care after an initial diagnosis was 22 days (IQR 6-147) for those with advanced HIV, compared to 19 days (IQR 4-119) for those with non-advanced HIV (p = 0.716). Clinic (adjusted odds ratio [AOR] 1.55, 95 % CI 1.09-2.20) and age (AOR 1.72 per unit increase in age category, 95 % CI 1.45-2.03) were associated with presenting with advanced HIV.

Conclusions: Presentation to care with advanced HIV was primarily due to delayed diagnosis, rather than delayed linkage to care after diagnosis. Variation by clinic suggests that outreach and other community-based efforts may drive earlier testing and linkage to care. Our findings highlight the ongoing importance of implementing strategies to encourage earlier HIV diagnosis, particularly among adults 30 years and older.

No MeSH data available.


Related in: MedlinePlus