Risk factors for late-stage HIV disease presentation at initial HIV diagnosis in Durban, South Africa.

<h4>Background</h4>After observing persistently low CD4 counts at initial HIV diagnosis in South Africa, we sought to determine risk factors for late-stage HIV disease presentation among adults.<h4>Methods</h4>We surveyed adults prior to HIV testing at four outpatient clinics...

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Autores principales:	Paul K Drain, Elena Losina, Gary Parker, Janet Giddy, Douglas Ross, Jeffrey N Katz, Sharon M Coleman, Laura M Bogart, Kenneth A Freedberg, Rochelle P Walensky, Ingrid V Bassett
Formato:	article
Lenguaje:	EN
Publicado:	Public Library of Science (PLoS) 2013
Materias:	Medicine R Science Q
Acceso en línea:	https://doaj.org/article/3c84a00e0e72447697f335128fbbeaad
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spelling	oai:doaj.org-article:3c84a00e0e72447697f335128fbbeaad2021-11-18T07:59:43ZRisk factors for late-stage HIV disease presentation at initial HIV diagnosis in Durban, South Africa.1932-620310.1371/journal.pone.0055305https://doaj.org/article/3c84a00e0e72447697f335128fbbeaad2013-01-01T00:00:00Zhttps://www.ncbi.nlm.nih.gov/pmc/articles/pmid/23383147/?tool=EBIhttps://doaj.org/toc/1932-6203<h4>Background</h4>After observing persistently low CD4 counts at initial HIV diagnosis in South Africa, we sought to determine risk factors for late-stage HIV disease presentation among adults.<h4>Methods</h4>We surveyed adults prior to HIV testing at four outpatient clinics in Durban from August 2010 to November 2011. All HIV-infected adults were offered CD4 testing, and late-stage HIV disease was defined as a CD4 count <100 cells/mm(3). We used multivariate regression models to determine the effects of sex, emotional health, social support, distance from clinic, employment, perceived barriers to receiving healthcare, and foregoing healthcare to use money for food, clothing, or housing ("competing needs to healthcare") on presentation with late-stage HIV disease.<h4>Results</h4>Among 3,669 adults screened, 830 were enrolled, newly-diagnosed with HIV and obtained a CD4 result. Among those, 279 (33.6%) presented with late-stage HIV disease. In multivariate analyses, participants who lived ≥5 kilometers from the test site [adjusted odds ratio (AOR) 2.8, 95% CI 1.7-4.7], reported competing needs to healthcare (AOR 1.7, 95% CI 1.2-2.4), were male (AOR 1.7, 95% CI 1.2-2.3), worked outside the home (AOR 1.5, 95% CI 1.1-2.1), perceived health service delivery barriers (AOR 1.5, 95% CI 1.1-2.1), and/or had poor emotional health (AOR 1.4, 95% CI 1.0-1.9) had higher odds of late-stage HIV disease presentation.<h4>Conclusions</h4>Independent risk factors for late-stage HIV disease presentation were from diverse domains, including geographic, economic, demographic, social, and psychosocial. These findings can inform various interventions, such as mobile testing or financial assistance, to reduce the risk of presentation with late-stage HIV disease.Paul K DrainElena LosinaGary ParkerJanet GiddyDouglas RossJeffrey N KatzSharon M ColemanLaura M BogartKenneth A FreedbergRochelle P WalenskyIngrid V BassettPublic Library of Science (PLoS)articleMedicineRScienceQENPLoS ONE, Vol 8, Iss 1, p e55305 (2013)
institution	DOAJ
collection	DOAJ
language	EN
topic	Medicine R Science Q
spellingShingle	Medicine R Science Q Paul K Drain Elena Losina Gary Parker Janet Giddy Douglas Ross Jeffrey N Katz Sharon M Coleman Laura M Bogart Kenneth A Freedberg Rochelle P Walensky Ingrid V Bassett Risk factors for late-stage HIV disease presentation at initial HIV diagnosis in Durban, South Africa.
description	<h4>Background</h4>After observing persistently low CD4 counts at initial HIV diagnosis in South Africa, we sought to determine risk factors for late-stage HIV disease presentation among adults.<h4>Methods</h4>We surveyed adults prior to HIV testing at four outpatient clinics in Durban from August 2010 to November 2011. All HIV-infected adults were offered CD4 testing, and late-stage HIV disease was defined as a CD4 count <100 cells/mm(3). We used multivariate regression models to determine the effects of sex, emotional health, social support, distance from clinic, employment, perceived barriers to receiving healthcare, and foregoing healthcare to use money for food, clothing, or housing ("competing needs to healthcare") on presentation with late-stage HIV disease.<h4>Results</h4>Among 3,669 adults screened, 830 were enrolled, newly-diagnosed with HIV and obtained a CD4 result. Among those, 279 (33.6%) presented with late-stage HIV disease. In multivariate analyses, participants who lived ≥5 kilometers from the test site [adjusted odds ratio (AOR) 2.8, 95% CI 1.7-4.7], reported competing needs to healthcare (AOR 1.7, 95% CI 1.2-2.4), were male (AOR 1.7, 95% CI 1.2-2.3), worked outside the home (AOR 1.5, 95% CI 1.1-2.1), perceived health service delivery barriers (AOR 1.5, 95% CI 1.1-2.1), and/or had poor emotional health (AOR 1.4, 95% CI 1.0-1.9) had higher odds of late-stage HIV disease presentation.<h4>Conclusions</h4>Independent risk factors for late-stage HIV disease presentation were from diverse domains, including geographic, economic, demographic, social, and psychosocial. These findings can inform various interventions, such as mobile testing or financial assistance, to reduce the risk of presentation with late-stage HIV disease.
format	article
author	Paul K Drain Elena Losina Gary Parker Janet Giddy Douglas Ross Jeffrey N Katz Sharon M Coleman Laura M Bogart Kenneth A Freedberg Rochelle P Walensky Ingrid V Bassett
author_facet	Paul K Drain Elena Losina Gary Parker Janet Giddy Douglas Ross Jeffrey N Katz Sharon M Coleman Laura M Bogart Kenneth A Freedberg Rochelle P Walensky Ingrid V Bassett
author_sort	Paul K Drain
title	Risk factors for late-stage HIV disease presentation at initial HIV diagnosis in Durban, South Africa.
title_short	Risk factors for late-stage HIV disease presentation at initial HIV diagnosis in Durban, South Africa.
title_full	Risk factors for late-stage HIV disease presentation at initial HIV diagnosis in Durban, South Africa.
title_fullStr	Risk factors for late-stage HIV disease presentation at initial HIV diagnosis in Durban, South Africa.
title_full_unstemmed	Risk factors for late-stage HIV disease presentation at initial HIV diagnosis in Durban, South Africa.
title_sort	risk factors for late-stage hiv disease presentation at initial hiv diagnosis in durban, south africa.
publisher	Public Library of Science (PLoS)
publishDate	2013
url	https://doaj.org/article/3c84a00e0e72447697f335128fbbeaad
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Risk factors for late-stage HIV disease presentation at initial HIV diagnosis in Durban, South Africa.

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