Determinants of late disease-stage presentation at diagnosis of HIV infection in Venezuela: a case-case comparison.
Determinants of late disease-stage presentation at diagnosis of HIV infection in Venezuela: a case-case comparison.
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DOI：
10.1186/1742-6405-5-6
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发表时间：
2008-04-16
影响因子：
2.2
通讯作者：
Tami, Adriana
中科院分区：
文献类型：
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作者：
Bonjour, Maeva A;Montagne, Morelba;Tami, Adriana
背景：虽然委内瑞拉有一个提供免费诊断和治疗的国家人类免疫缺陷病毒(艾滋病毒)方案，但41%的患者在疾病后期进行诊断，这表明获得护理的机会可能仍然有限。我们的研究旨在通过病例对病例的比较来确定影响HIV诊断延迟的因素。在委内瑞拉卡拉博沃地区的区域艾滋病毒参考中心进行了一项横断面调查。2005年5月至2006年10月期间，纳入了225名在计算机辅助教学中被诊断为艾滋病毒的患者，并从医疗档案中收集了人口统计学、行为和医学特征。通过访谈，从129名符合条件的受试者中获得了社会经济和行为因素。根据美国亚特兰大疾病控制和预防中心1993年的分类，诊断时的“晚期表现”被定义为疾病B期或C期的患者，而“早期表现”被定义为疾病A期的诊断。结果：在225例受试者中，91例(40%)被定义为晚期表现。在受访的次级样本中也有类似的比例(51/129)。在多因素模型中，年龄较大(>；30岁)、男性异性恋者、较低的社会经济地位、认为自己的伴侣是忠诚的、住在离cai<gt；/=25公里的地方与延迟诊断呈正相关。女性迟到的可能性低于异性恋男性(优势比=0.23，P=0.06)。HIV检测的主要障碍是对HIV/AIDS知识水平低，对免费HIV计划缺乏认识，缺乏对HIV感染风险的感知，对HIV相关污名的恐惧，对检测地点缺乏保密性的恐惧和后勤障碍。结论：尽管委内瑞拉有免费的HIV计划，但贫困和与对HIV和该计划本身缺乏知识和认识有关的障碍是延迟提交HIV诊断的重要决定因素。这项研究还表明，女性；异性恋、双性恋和同性恋男性可能有不同的测试途径，每个亚群中与迟发有关的因素也不同。必须努力：i)提高对艾滋病毒/艾滋病和该方案的认识；ii)找出与每个分组的艾滋病毒诊断延迟有关的具体因素，以帮助制定有针对性的公共卫生干预措施，改善委内瑞拉和其他地方艾滋病毒/艾滋病感染者的早期诊断和预后。
BACKGROUND: Although Venezuela has a National Human Immunodeficiency Virus (HIV) Program offering free diagnosis and treatment, 41% of patients present for diagnosis at a later disease-stage, indicating that access to care may still be limited. Our study aimed to identify factors influencing delay in presenting for HIV-diagnosis using a case-case comparison. A cross-sectional survey was performed at the Regional HIV Reference Centre (CAI), Carabobo Region, Venezuela. Between May 2005 and October 2006 225 patients diagnosed with HIV at CAI were included and demographic, behavioural and medical characteristics collected from medical files. Socio-economic and behavioural factors were obtained from 129 eligible subjects through interviews. "Late presentation" at diagnosis was defined as patients classified with disease-stage B or C according to the 1993 Centers for Disease Control and Prevention (Atlanta, USA) classification, and "early presentation" defined as diagnosis in disease-stage A.RESULTS: Of 225 subjects, 91 (40%) were defined as late presenters. A similar proportion (51/129) was obtained in the interviewed sub-sample. Older age (>30 years), male heterosexuality, lower socio-economic status, perceiving ones partner to be faithful and living >/= 25 km from the CAI were positively associated with late diagnosis in a multivariate model. Females were less likely to present late than heterosexual males (odds ratio = 0.23, P = 0.06). The main barriers to HIV testing were low knowledge of HIV/AIDS, lack of awareness of the free HIV program, lack of perceived risk of HIV-infection, fear for HIV-related stigma, fear for lack of confidentiality at testing site and logistic barriers.CONCLUSION: Despite the free Venezuelan HIV Program, poverty and barriers related to lack of knowledge and awareness of both HIV and the Program itself were important determinants in late presentation at HIV diagnosis. This study also indicates that women; heterosexual, bisexual and homosexual men might have different pathways to testing and different factors related to late presentation in each subgroup. Efforts must be directed to i) increase awareness of HIV/AIDS and the Program and ii) the identification of specific factors associated with delay in HIV diagnosis per subgroup, to help develop targeted public health interventions improving early diagnosis and prognosis of people living with HIV/AIDS in Venezuela and elsewhere.