Premium
Patients who present late to HIV care and associated risk factors in N igeria
Author(s) -
Agaba PA,
Meloni ST,
Sule HM,
Agbaji OO,
Ekeh PN,
Job GC,
Nyango N,
Ugoagwu PO,
Imade GE,
Idoko JA,
Kanki PJ
Publication year - 2014
Publication title -
hiv medicine
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.53
H-Index - 79
eISSN - 1468-1293
pISSN - 1464-2662
DOI - 10.1111/hiv.12125
Subject(s) - medicine , confidence interval , odds ratio , logistic regression , referral , retrospective cohort study , public health , pediatrics , family medicine , nursing
Objectives Our objectives were to assess trends in late presentation and advanced HIV disease ( AHD ) and determine associated risk factors. Methods We conducted a retrospective cohort analysis of patients who had received care and treatment at the AIDS P revention I nitiative N igeria P lus ( APIN)/H arvard S chool of P ublic H ealth− P resident's E mergency P lan for AIDS R elief ( PEPFAR ) programme at the J os U niversity T eaching H ospital, J os, N igeria from 2005 to 2010. We used the E uropean Consensus Definition to assess trends in late presentation ( CD4 count < 350 cells/μL or AIDS ‐defining illness) and AHD ( CD4 count < 200 cells/μL or AIDS ‐defining illness) and evaluated associated risk factors using logistic regression methods. Results Among 14 487 eligible patients, 12 401 (85.6%) were late presenters and 9127 (63.0%) presented with AHD . Late presentation decreased from 88.9% in 2005 to 80.1% in 2010 ( P < 0.001). Similarly, AHD decreased from 67.8% in 2005 to 53.6% in 2010 ( P < 0.001). In logistic regression models adjusting for sociodemographic and biological variables, male sex [adjusted odds ratio ( aOR ) = 1.80; 95% confidence interval ( CI ) 1.60–2.04], older age ( aOR = 1.37; 95% CI 1.22–1.54), civil service employment ( aOR = 1.48; 95% CI 1.00–2.21), referral from out‐patient ( aOR = 2.18; 95% CI 1.53–3.08) and in‐patient ( aOR = 1.55; 95% CI 1.11–2.17) services, and hepatitis B virus ( aOR = 1.43; 95% CI 1.26–1.63) and hepatitis C virus ( aOR = 1.18; 95% CI 1.02–1.37) coinfections were associated with late presentation. Predictors of AHD were male sex ( aOR = 1.67; 95% CI 1.54–1.82), older age ( aOR = 1.26; 95% CI 1.16–1.36), unemployment ( aOR = 1.34; 95% CI 1.00–1.79), referral from out‐patient ( aOR = 2.40; 95% CI 1.84–3.14) and in‐patient ( aOR = 1.97; 95% CI 1.51–2.57) services and hepatitis B virus coinfection ( aOR = 1.30; 95% CI 1.19–1.42). Conclusions Efforts to reduce the proportion of patients who first seek care at late stages of disease are needed. The identified risk factors should be utilized in formulating targeted public health interventions to improve early diagnosis and presentation for HIV care.