Factors Associated With Late Presentation To HIV/AIDS Care, South Wollo Zone: A Case-Control Study

Abstract

Background:Access to free antiretroviral therapy in sub-Saharan Africa has been steadily increasing, and the success of large-scale antiretroviral therapy programs depends on early initiation of HIV care.Despite the proven benefits conferred by early human immunodeficiency virus diagnosis and presentation to care, delays in HIV/AIDS care are common; these delays are not fully understood. Objective: To examine factors associated with late presentation to HIV/AIDS care among HIV-positive individuals attending HIV/AIDS care in public hospitals of South Wollo Zone. Methods: Unmatched case-control study was carried out from March1-31, 2010. The source populations were people living with HIV/AIDS who were enrolled in the ART clinic of the hospitals between March 2009 and February 2010.The study population consisted of 160 cases and 160 controls. Cases were HIV positive individuals who had WHO clinical stage III or IV or CD4 count of less than 200/uL at the time of first presentation to ART clinic of the hospitals.The impact of the variables on the likelihood of late presentation was analysed by forward logistic regression method.Data were collected by pre-tested questionnaires and in-depth interview guides. Results: In multiple logistic regression analysis, HIV positive individuals who live with families [AOR= 3.29, 95%CI: 1.279 -8.447)], HIV positive individuals who live with renting house [AOR= 2.52, (95%CI: 1.093- 5.793)], non-pregnant women [AOR= 9.3, (95% CI: 1.928 -44.824)], HIV positive individuals who perceived ART have side effects [AOR= 6.23, 95%CI: 1.63,23.8)],people living with HIV/AIDS who perceived stigma and discrimination [AOR= 3.1, (95% CI: 1.094 , 8.764)], HIV positive individuals tested with sickness/HIV related symptoms [A OR= 2.62 , (95% CI: 1.258 5.437)],HIV positive individuals who did not disclose their HIV status for their partner [ AOR= 2.78 , (95% CI: 1.023,7.56)], most of the times alcohol user HIV positive individuals [AOR= 3.55, (95% CI: 1.63 -7.71)] and HIV positive individuals who spent more than 120 months with partner at HIV diagnosis[AOR= 5.86, 95% CI: 1.35-25.41)] were significantly associated with late presentation to HIV/AIDS care. Conclusions: Non-pregnant women, who live with families, who live in renting house, non-disclosure of HIV status to partner, who consume alcohol, who perceive HIV stigma, who have symptoms /sickness at HIV diagnosis, who perceive ART side effects and long standing couples were strongly associated with late presentation to HIV/AIDS care.Sex and educational status of the respondents were not associated with late presentation to HIV/AIDS care. Recommendation: The hospitals should strengthen the health education campaign aimed at reaching the entire population in order to increase awareness and knowledge about HIV/AIDS and its care that could prompt HIV positive individuals to present for care earlier.