Advanced HIV disease at presentation to care in Nairobi, Kenya: late diagnosis or delayed linkage to care?--a cross-sectional study.
Advanced HIV disease at presentation to care in Nairobi, Kenya: late diagnosis or delayed linkage to care?--a cross-sectional study.
复制标题
DOI：
10.1186/s12879-016-1500-8
复制
发表时间：
2016-04-18
影响因子：
3.7
通讯作者：
Ekström AM
中科院分区：
文献类型：
--
作者：
van der Kop ML;Thabane L;Awiti PO;Muhula S;Kyomuhangi LB;Lester RT;Ekström AM
在撒哈拉以南非洲，晚期艾滋病毒患者接受护理很常见，这会增加患严重疾病和死亡的风险;然而，目前尚不清楚这是否是诊断较晚或诊断后延迟寻求护理的结果。这项横断面研究的目的是确定与晚期艾滋病毒相关的因素，以及这是否是由于晚期诊断或延迟获得护理。2013年至2015年期间，在肯尼亚内罗毕低收入地区的两个诊所招募了前来接受护理的成年人。如果参与者的CD 4计数低于200个细胞/μL，或处于WHO第4阶段，则认为他们患有晚期HIV。以前的艾滋病毒诊断信息收集使用访谈管理的问卷调查。Logistic回归分析用于确定临床和社会人口统计学因素与晚期HIV之间的关联。在接受艾滋病毒护理的753名参与者中，248人（33%）患有晚期艾滋病毒。近60%（146/248）的晚期艾滋病毒感染者以前曾被诊断过，其中大多数（102/145; 70%）在初次诊断后三个月内接受治疗。对于晚期HIV患者，初次诊断后到HIV治疗的中位时间为22天（IQR 6-147），而非晚期HIV患者为19天（IQR 4-119）（p = 0.716）。临床（调整的比值比[AOR] 1.55，95%CI 1.09-2.20）和年龄（年龄类别每增加一个单位，AOR 1.72，95%CI 1.45-2.03）与晚期HIV相关。晚期艾滋病毒患者接受护理主要是由于诊断延迟，而不是诊断后与护理的延迟联系。诊所的差异表明，外展和其他以社区为基础的努力可能会推动早期检测和与护理的联系。我们的研究结果强调了实施鼓励早期艾滋病毒诊断战略的持续重要性，特别是在30岁及以上的成年人中。
Presenting to care with advanced HIV is common in sub-Saharan Africa and increases the risk of severe disease and death; however, it remains unclear whether this is a consequence of late diagnosis or a delay in seeking care after diagnosis. The objectives of this cross-sectional study were to determine factors associated with advanced HIV at presentation to care and whether this was due to late diagnosis or delays in accessing care. Between 2013 and 2015, adults presenting to care were recruited at two clinics in low-income areas of Nairobi, Kenya. Participants were considered to have advanced HIV if their CD4 count was below 200 cells/μL, or they were in WHO stage 4. Information on previous HIV diagnoses was collected using interviewer-administered questionnaires. Logistic regression was used to determine the association between clinical and socio-demographic factors and advanced HIV. Of 753 participants presenting to HIV care, 248 (33 %) had advanced HIV. Almost 60 % (146/248) of those presenting with advanced HIV had been previously diagnosed, most of whom (102/145; 70 %) presented to care within three months of their initial diagnosis. The median time to presentation to HIV care after an initial diagnosis was 22 days (IQR 6-147) for those with advanced HIV, compared to 19 days (IQR 4-119) for those with non-advanced HIV (p = 0.716). Clinic (adjusted odds ratio [AOR] 1.55, 95 % CI 1.09–2.20) and age (AOR 1.72 per unit increase in age category, 95 % CI 1.45–2.03) were associated with presenting with advanced HIV. Presentation to care with advanced HIV was primarily due to delayed diagnosis, rather than delayed linkage to care after diagnosis. Variation by clinic suggests that outreach and other community-based efforts may drive earlier testing and linkage to care. Our findings highlight the ongoing importance of implementing strategies to encourage earlier HIV diagnosis, particularly among adults 30 years and older.