Factors Associated with Delayed Enrollment in HIV Medical Care among HIV-Positive Individuals in Odessa Region, Ukraine

Abstract

In Ukraine, about one-third of identified HIV-positive individuals are not connected to care. We conducted a cross-sectional survey (n = 200) among patients registered at Odessa AIDS centers in October to December 2011. Factors associated with delayed enrollment in HIV care (>3 months since positive HIV test) were evaluated using logistic regression. Among study participants (mean age 35 ± 8.2 years, 47.5% female, 42.5% reported history of injecting drugs), 55% delayed HIV care enrollment. Odds of delayed enrollment were higher for those with lower educational attainment (adjusted odds ratio [aOR]: 2.65, 95% confidence interval [CI]: 1.04-6.76), not feeling ill (aOR: 2.98, 95% CI: 1.50-5.93), or not having time to go to the AIDS center (aOR: 3.89, 95% CI: 1.39-10.89); injection drug use was not associated with delayed enrollment. Programs linking HIV-positive individuals to specialized care should address enrollment barriers and include education on HIV care benefits and case management for direct linkage to care. HIV testing and treatment should be coupled to ensure a continuum of care.

Linkage to HIV care following diagnosis in the WHO European Region: A systematic review and meta-analysis, 2006-2017

“…All 24 studies presented data on linkage to care following diagnosis ( Table 1 ); however, two studies [ 20 , 31 ] have been excluded from the descriptive linkage to care analysis as more recent estimates were available from other studies using the same data source. [ 17 , 34 ] These two studies have been included in the review as they identify risk factors for poor linkage.…”

Factors associated with delayed linkage to care following HIV diagnosis in the WHO European Region

“…Delayed access to care was found to be associated with higher CD4 counts at diagnosis; these patients are more likely to be asymptomatic and feel well. “Not feeling ill” is a known predictor of postponing access to medical care . The association between younger age and delayed linkage to care has also been documented .…”

“…A second limitation of these analyses was that due to the retrospective nature of this study, we were restricted to the basic demographic data available through the European surveillance of HIV. Other factors known to be associated with delayed linkage to care were not able to be captured such as education , HIV diagnosis setting , stigma and discrimination and individual resource limitations .…”

Oportunidade de vinculação de pessoas vivendo com HIV em um serviço especializado de saúde, Belo Horizonte (MG)

“…This finding is corroborated by other studies that point out that starting health care late is previously associated with a higher CD4+ T count 32,35 . In addition, other researches show that self-perception of not feeling sick is associated with later linkage 26,36 . Also, patients with low CD4+ T counts, especially less than 100 cells/mm 3 , are at higher risk for polypharmacy, opportunistic infections, and other HIV-related complications 31,34,37,38 .…”