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Risk Factors for Late-Stage HIV Disease Presentation at Initial HIV Diagnosis in Durban, South Africa
BACKGROUND: 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. METHODS: We surveyed adults prior to HIV testing at four outpatient clinics in Durban from August 2010 to Novemb...
Autores principales: | , , , , , , , , , , |
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Formato: | Online Artículo Texto |
Lenguaje: | English |
Publicado: |
Public Library of Science
2013
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Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3557232/ https://www.ncbi.nlm.nih.gov/pubmed/23383147 http://dx.doi.org/10.1371/journal.pone.0055305 |
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author | Drain, Paul K. Losina, Elena Parker, Gary Giddy, Janet Ross, Douglas Katz, Jeffrey N. Coleman, Sharon M. Bogart, Laura M. Freedberg, Kenneth A. Walensky, Rochelle P. Bassett, Ingrid V. |
author_facet | Drain, Paul K. Losina, Elena Parker, Gary Giddy, Janet Ross, Douglas Katz, Jeffrey N. Coleman, Sharon M. Bogart, Laura M. Freedberg, Kenneth A. Walensky, Rochelle P. Bassett, Ingrid V. |
author_sort | Drain, Paul K. |
collection | PubMed |
description | BACKGROUND: 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. METHODS: 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. RESULTS: 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. CONCLUSIONS: 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 | Online Article Text |
id | pubmed-3557232 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2013 |
publisher | Public Library of Science |
record_format | MEDLINE/PubMed |
spelling | pubmed-35572322013-02-04 Risk Factors for Late-Stage HIV Disease Presentation at Initial HIV Diagnosis in Durban, South Africa Drain, Paul K. Losina, Elena Parker, Gary Giddy, Janet Ross, Douglas Katz, Jeffrey N. Coleman, Sharon M. Bogart, Laura M. Freedberg, Kenneth A. Walensky, Rochelle P. Bassett, Ingrid V. PLoS One Research Article BACKGROUND: 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. METHODS: 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. RESULTS: 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. CONCLUSIONS: 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. Public Library of Science 2013-01-28 /pmc/articles/PMC3557232/ /pubmed/23383147 http://dx.doi.org/10.1371/journal.pone.0055305 Text en © 2013 Drain et al http://creativecommons.org/licenses/by/4.0/ This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are properly credited. |
spellingShingle | Research Article Drain, Paul K. Losina, Elena Parker, Gary Giddy, Janet Ross, Douglas Katz, Jeffrey N. Coleman, Sharon M. Bogart, Laura M. Freedberg, Kenneth A. Walensky, Rochelle P. Bassett, Ingrid V. Risk Factors for Late-Stage HIV Disease Presentation at Initial HIV Diagnosis in Durban, South Africa |
title | 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_short | 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 |
topic | Research Article |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3557232/ https://www.ncbi.nlm.nih.gov/pubmed/23383147 http://dx.doi.org/10.1371/journal.pone.0055305 |
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