PMID- 24580742
OWN - NLM
STAT- MEDLINE
DCOM- 20150212
LR  - 20140721
IS  - 1468-1293 (Electronic)
IS  - 1464-2662 (Linking)
VI  - 15
IP  - 7
DP  - 2014 Aug
TI  - Patients who present late to HIV care and associated risk factors in Nigeria.
PG  - 396-405
LID - 10.1111/hiv.12125 [doi]
AB  - OBJECTIVES: Our objectives were to assess trends in late presentation and 
      advanced HIV disease (AHD) and determine associated risk factors. METHODS: We 
      conducted a retrospective cohort analysis of patients who had received care and 
      treatment at the AIDS Prevention Initiative Nigeria Plus (APIN)/Harvard School of 
      Public Health-President's Emergency Plan for AIDS Relief (PEPFAR) programme at 
      the Jos University Teaching Hospital, Jos, Nigeria from 2005 to 2010. We used the 
      European Consensus Definition to assess trends in late presentation (CD4 count 
      < 350 cells/muL or AIDS-defining illness) and AHD (CD4 count < 200 cells/muL or 
      AIDS-defining illness) and evaluated associated risk factors using logistic 
      regression methods. RESULTS: Among 14,487 eligible patients, 12,401 (85.6%) were 
      late presenters and 9127 (63.0%) presented with AHD. Late presentation decreased 
      from 88.9% in 2005 to 80.1% in 2010 (P < 0.001). Similarly, AHD decreased from 
      67.8% in 2005 to 53.6% in 2010 (P < 0.001). In logistic regression models 
      adjusting for sociodemographic and biological variables, male sex [adjusted odds 
      ratio (aOR) = 1.80; 95% confidence interval (CI) 1.60-2.04], older age 
      (aOR = 1.37; 95% CI 1.22-1.54), civil service employment (aOR = 1.48; 95% CI 
      1.00-2.21), referral from out-patient (aOR = 2.18; 95% CI 1.53-3.08) and 
      in-patient (aOR = 1.55; 95% CI 1.11-2.17) services, and hepatitis B virus 
      (aOR = 1.43; 95% CI 1.26-1.63) and hepatitis C virus (aOR = 1.18; 95% CI 
      1.02-1.37) coinfections were associated with late presentation. Predictors of AHD 
      were male sex (aOR = 1.67; 95% CI 1.54-1.82), older age (aOR = 1.26; 95% CI 
      1.16-1.36), unemployment (aOR = 1.34; 95% CI 1.00-1.79), referral from 
      out-patient (aOR = 2.40; 95% CI 1.84-3.14) and in-patient (aOR = 1.97; 95% CI 
      1.51-2.57) services and hepatitis B virus coinfection (aOR = 1.30; 95% CI 
      1.19-1.42). CONCLUSIONS: Efforts to reduce the proportion of patients who first 
      seek care at late stages of disease are needed. The identified risk factors 
      should be utilized in formulating targeted public health interventions to improve 
      early diagnosis and presentation for HIV care.
CI  - (c) 2014 British HIV Association.
FAU - Agaba, P A
AU  - Agaba PA
AD  - Department of Family Medicine, University of Jos, Jos, Nigeria; AIDS Prevention 
      Initiative Nigeria Plus, Jos University Teaching Hospital, Jos, Nigeria.
FAU - Meloni, S T
AU  - Meloni ST
FAU - Sule, H M
AU  - Sule HM
FAU - Agbaji, O O
AU  - Agbaji OO
FAU - Ekeh, P N
AU  - Ekeh PN
FAU - Job, G C
AU  - Job GC
FAU - Nyango, N
AU  - Nyango N
FAU - Ugoagwu, P O
AU  - Ugoagwu PO
FAU - Imade, G E
AU  - Imade GE
FAU - Idoko, J A
AU  - Idoko JA
FAU - Kanki, P J
AU  - Kanki PJ
LA  - eng
GR  - U51HA02522-01-01/PHS HHS/United States
PT  - Journal Article
PT  - Research Support, U.S. Gov't, P.H.S.
DEP - 20140120
PL  - England
TA  - HIV Med
JT  - HIV medicine
JID - 100897392
SB  - IM
MH  - AIDS Serodiagnosis/*statistics & numerical data
MH  - Adolescent
MH  - Adult
MH  - Aged
MH  - Aged, 80 and over
MH  - CD4 Lymphocyte Count
MH  - Female
MH  - HIV Infections/blood/*diagnosis
MH  - Humans
MH  - Logistic Models
MH  - Male
MH  - Middle Aged
MH  - Nigeria
MH  - Patient Acceptance of Health Care/*statistics & numerical data
MH  - Retrospective Studies
MH  - Risk Factors
MH  - Socioeconomic Factors
MH  - Time Factors
MH  - Young Adult
OTO - NOTNLM
OT  - HIV
OT  - Nigeria
OT  - advanced HIV disease
OT  - late presentation
OT  - risk factors
EDAT- 2014/03/04 06:00
MHDA- 2015/02/13 06:00
CRDT- 2014/03/04 06:00
PHST- 2013/12/03 00:00 [accepted]
PHST- 2014/03/04 06:00 [entrez]
PHST- 2014/03/04 06:00 [pubmed]
PHST- 2015/02/13 06:00 [medline]
AID - 10.1111/hiv.12125 [doi]
PST - ppublish
SO  - HIV Med. 2014 Aug;15(7):396-405. doi: 10.1111/hiv.12125. Epub 2014 Jan 20.