Late HIV diagnosis and delay in CD4 count measurement among HIV-infected patients in Southern Thailand
ABSTRACT The objectives of this study were to evaluate timeliness of HIV testing and of getting CD4 count measured and their associated factors in Southern Thailand. Between July 2004 and February 2005, consenting HIV-positive patients from seven public hospitals in Songkhla province, Southern Thailand were interviewed. Outcomes were late HIV diagnosis (having HIV-related symptoms at the time of first positive test) and the time between HIV diagnosis and first CD4 count being measured. Of 402 study patients, 55% were late HIV-diagnosed. Factors independently associated with late HIV diagnosis were age above 30 years, male and being unemployed with respective odd ratios (95% CI) of 3.10 (1.90-5.07), 7.95 (4.52-13.99), and 2.14 (1.22-3.76). Only 34% and 47% received CD4 assessment within 6 and 12 months of HIV diagnosis, respectively. Median of first-known CD4 count was 73 (IQR 16-169) and 22 (IQR 9-85) cells/microl among asymptomatic and symptomatic HIV-diagnosed patients, respectively. Common predictors for shortened delay of CD4 count measured among symptomatic and asymptomatic HIV-diagnosed patients were: infection through sexual contact (HR=1.61; 95%CI 1.12-2.33) and receiving posttest counseling (HR 1.71; 95%CI 1.15-2.52). Among the asymptomatic, those aged >25-30 years had significantly shortened delay (HR=2.18; 95%CI 1.50-3.18) compared with the younger age group as did those aged >30 years (HR=1.94; 95%CI 1.32-2.85). Such age effect on the delay was absent in the symptomatic group. Attempts to diagnose HIV at an earlier stage and timely CD4 count measured are needed.
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ABSTRACT: Background Late diagnosis of HIV infection is common. We aim to assess the proportion of newly diagnosed HIV cases receiving timely baseline CD4 count testing and the associated factors in China. Methods Data were extracted from the Chinese HIV/AIDS Comprehensive Response Information Management System. Adult patients over 15 years old who had been newly diagnosed with HIV infection in China between 2006 and 2012 were identified. The study cohort comprised individuals who had a measured baseline CD4 count. Results Among 388,496 newly identified HIV cases, the median baseline CD4 count was 294 cells/µl (IQR: 130–454), and over half (N = 130,442, 58.8%) were less than 350 cells/µl. The median baseline CD4 count increased from 221 (IQR: 63–410) in 2006 to 314 (IQR: 159–460) in 2012. A slight majority of patients (N = 221,980, 57.1%) received baseline CD4 count testing within 6 months of diagnosis. The proportion of individuals who received timely baseline CD4 count testing increased significantly from 20.0% in 2006 to 76.9% in 2012. Factors associated with failing to receiving timely CD4 count testing were: being male (OR: 1.17, 95% CI: 1.15–1.19), age 55 years or older (OR:1.03, 95% CI: 1.00–1.06), educational attainment of primary school education or below (OR: 1.30, 95% CI: 1.28–1.32), infection with HIV through injection drug use (OR: 2.07, 95% CI: 2.02–2.12) or sexual contact and injection drug use (OR: 1.87, 95% CI: 1.76–1.99), diagnosis in a hospital (OR: 1.91, 95% CI: 1.88–1.95) or in a detention center (OR: 1.75, 95% CI: 1.70–1.80), and employment as a migrant worker (OR:1.55, 95% CI:1.53–1.58). Conclusion The proportion of newly identified HIV patients receiving timely baseline CD4 testing has increased significantly in China from 2006–2012. Continued effort is needed for further promotion of early HIV diagnosis and timely baseline CD4 cell count testing.PLoS ONE 06/2014; 9(6):e96098. DOI:10.1371/journal.pone.0096098 · 3.53 Impact Factor
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ABSTRACT: Background 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. Methodology 196 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. Results Common 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). Conclusion Delayed 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.PLoS ONE 10/2014; 9(10):e108939. DOI:10.1371/journal.pone.0108939 · 3.53 Impact Factor
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ABSTRACT: Late diagnosis of human immunodeficiency virus (HIV) infection remains a challenging issue, especially in young population, which accounts for approximately half of new HIV infections. This study aimed to assess factors associated with late diagnosis of HIV infection in young people. It employed a hospital-based case-control design, conducted during January 2012 through August 2013. A total of 193 patients aged 18-25 years old from 21 hospitals across Thailand were studied. Late diagnosis was defined as presentation when the CD4 cell count was less than 350 cells/µL within 12 months of the first HIV diagnosis, or AIDS-defining event is present within 12 months of the first HIV diagnosis. Factors associated with the late diagnosis of HIV were those who: did not live with their parent (OR 3.87; 95% CI 1.40-10.66), had no children (OR 3.25; 95% CI 1.27-8.31), had their first sexual intercourse at age older than 18 years (OR 4.25; 95% CI 1.27-14.22), had same-age or older partners (OR 3.36; 95% CI 1.39-8.08), were substance users (OR 3.65; 95% CI 1.22-10.88), believed they changed their behaviors after receiving HIV education (OR 2.48; 95% CI 1.02-5.99), and sought care at regional (OR 3.19; 95% 1.31-7.79) or general hospitals (OR 3.34; 95% 1.07-10.35). Strategies for early HIV detection in young people should be reconsidered; particularly the involvement of parents and targeting the right population.AIDS Care 02/2015; 27(5):1-9. DOI:10.1080/09540121.2014.986049 · 1.60 Impact Factor