Factors associated with late presentation to HIV/AIDS care in South Wollo ZoneEthiopia: a case-control study

Abstract

BackgroundAccess to free antiretroviral therapy in Sub-Saharan Africa has been steadily increasing. The success of large-scale antiretroviral therapy programs depends on early initiation of HIV/AIDs care. The purpose of the study was to examine factors associated with late presentation to HIV/AIDS care.MethodsA case-control study was conducted in Dessie referral and Borumeda district hospitals from March 1 to 31, 2010, northern Ethiopia. A total of 320 study participants (160 cases and 160 controls) were included in the study. Cases were people living with HIV/AIDS (PLHA) who had a WHO clinical stage of III or IV or a CD4 lymphocyte count of less than 200/uL at the time of the first presentation to antiretroviral treatment (ART) clinics. Controls were PLHA who had WHO stage I or II or a CD4 lymphocyte count of 200/uL or more irrespective of clinical staging at the time of first presentation to the ART clinics of the hospitals cases and controls were interviewed by trained nurses using a pre-tested and structured questionnaire. In-depth interviews were conducted with ten health workers and eight PLHA.ResultsPLHA who live with their families [OR = 3.29, 95%CI: 1.28-8.45)], lived in a rented house [OR = 2.52, 95%CI: 1.09-5.79], non-pregnant women [OR = 9.3, 95% CI: 1.93-44.82], who perceived ART have many side effects [OR = 6.23, 95%CI:1.63,23.82)], who perceived HIV as stigmatizing disease [OR = 3.1, 95% CI: 1.09-8.76], who tested with sickness/symptoms [OR = 2.62, 95% CI: 1.26-5.44], who did not disclose their HIV status for their partner [OR = 2.78, 95% CI: 1.02-7.56], frequent alcohol users [OR = 3.55, 95% CI: 1.63-7.71] and who spent more than 120 months with partner at HIV diagnosis[OR = 5.86, 95% CI: 1.35-25.41] were significantly associated with late presentation to HIV/AIDS care. The qualitative finding revealed low awareness, non-disclosure, perceived ART side effects and HIV stigma were the major barriers for late presentation to HIV/AIDS care.ConclusionsEfforts to increase early initiation of HIV/AIDS care should focus on addressing patient's concerns such as stigma, drug side effects and disclosure.

Barriers to access to antiretroviral treatment for HIV-positive tuberculosis patients in Windhoek, Namibia

“…A semi-structured interview guide was developed based on a literature review [9][10][11][12][13][14][15][16][17][18][19]21] and pre-tested with Namibian healthcare professionals. The focus was a discussion of potential barriers to access to ART for HIV-positive TB patients in Namibia.…”

“…The expected medication burden also causes concerns, mainly due to possible toxicities and interactions [14] but also regarding the amount and quality of food needed while on treatment [12]. Patients should therefore receive thorough information up-front to clarify possible misconceptions [12,16].…”

“…It puts patients under psychosocial distress and may lead to a delay or rejection of HIV testing [15] and ART commencement [16]. Knowledge about the linkage of TB and HIV and about the benefits of ART is regarded as crucial for accepting the offer to get tested [11].…”

“…Research conducted in other African countries revealed various barriers to accessing ART for TB/HIV co-infected patients at the health-system, healthcare-worker and patient/community level [9][10][11][12][13][14][15][16][17][18][19], yet there are no publications from the Namibian context. This study is the first to research underlying causes for the low proportion of ART uptake among HIV-positive TB patients in Namibia.…”

Adding Fuel to the Fire: Alcohol’s Effect on the HIV Epidemic in Sub-Saharan Africa

“…Few studies have reported on the association between late presentation and alcohol consumption in SSA, and the results have been mixed. On one hand, a case control study in an HIV clinic in Ethiopia found an association between late presentation (WHO HIV stage 3 or 4 or CD4 cell count<200) and frequent alcohol consumption [30], while a cross sectional study of an HIV clinic in Uganda found that alcohol consumption in the past year was associated with presentation with early-stage HIV (WHO HIV stage 1 or 2) [31].…”