Factors associated with late diagnosis and delayed presentation of Hiv/aids patients at the Kenyatta Hospital Comprehensive Care Centre
Abstract
Introduction
Ensuring timely access to care for persons with HIV is an important public health goal.
This study aimed to identify factors associated with late HIV diagnosis and delayed
presentation to medical care after testing Hiv-positive,
Objectives
To determine the association between the demographic, socio-economic & behavioral
factors with late HIV testing and delayed presentation to care at KNH CCC
Methods
A cross-sectional survey was carried out. Two hundred and nineteen patients with Hiv
infection were consecutively recruited from the Comprehensive Care Centre at the
Kenyatta National Hospital. Patients diagnosed with HIV infection presenting for the first
time were recruited and an interviewer-administered questionnaire was used to collect
information about participants' demographic, socio-economic, behavioral and clinical data.
Thereafter, a detailed physical examination was conducted with confirmatory laboratory
tests as necessary and participants staged according to WHO Staging System. "Late
diagnosis" was defined as patients with a CD4 count <200 /mm3 or World Health
Organization Clinical Stage 3 and 4 disease at enrollment while "Delayed presention"
was when 3 months had elapsed between the date of their first HlV-positive test and their presentation for HIV care.
Results
Two hundred and nineteen subjects were interviewed. The mean age was 35 years and
there were 137 (63%) females. Fifty seven percent were married. Among the 219 study
subjects, 107 (49%) were defined as late testers while 23 (10%) were defined as delayed presenters. Subjects who tested for health related reasons were more likely to be diagnosed late [OR=3.284 (1.71-6.33), p=0.0000]. Persons indicating "fear for stigma" as a barrier were almost 3 times less likely to delay presentation after testing Hiv- positive [OR=0.36(0.14-0.95), p=O.033]. There was no association between patients' demographic,
socio-economic and behavioral characteristics such as age, sex, marital status, level of
education, residence, home ownership, sexual contacts, number of sex partners and
perception of risk with either late diagnosis or delayed presentation to care.
Conclusion
Late diagnosis of Hiv infection is a significant problem. Diagnosis usually occurs in the
course of medical care, often during care for complications of HIV. Improved HIV testing
strategies may allow for more timely diagnosis of HIV infection, which may benefit both
the infected individual and society.
Citation
Master Of Medicine (internal Medicine), University of Nairobi, 2009Publisher
University of Nairobi Faculty of medicine