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Risk Factors for Delayed Entrance into Care after Diagnosis among Patients with Late-Stage HIV Disease in Southern Vietnam

BACKGROUND: We surveyed HIV patients with late-stage disease in southern Vietnam to determine if barriers to access and service quality resulted in late HIV testing and delays from initial diagnosis to entry into HIV care. METHODOLOGY: 196 adult patients at public HIV clinics with CD4 counts less th...

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Autores principales: Rangarajan, Suresh, Tram, Hoang Nguyen Bao, Todd, Catherine S., Thinh, Tran, Hung, Van, Hieu, Pham Thanh, Hanh, Tran My, Chau, Khong Minh, Lam, Nguyen Danh, Hung, Pham Tri, West, Gary, Colby, Donn
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Public Library of Science 2014
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4199603/
https://www.ncbi.nlm.nih.gov/pubmed/25330196
http://dx.doi.org/10.1371/journal.pone.0108939
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author Rangarajan, Suresh
Tram, Hoang Nguyen Bao
Todd, Catherine S.
Thinh, Tran
Hung, Van
Hieu, Pham Thanh
Hanh, Tran My
Chau, Khong Minh
Lam, Nguyen Danh
Hung, Pham Tri
West, Gary
Colby, Donn
author_facet Rangarajan, Suresh
Tram, Hoang Nguyen Bao
Todd, Catherine S.
Thinh, Tran
Hung, Van
Hieu, Pham Thanh
Hanh, Tran My
Chau, Khong Minh
Lam, Nguyen Danh
Hung, Pham Tri
West, Gary
Colby, Donn
author_sort Rangarajan, Suresh
collection PubMed
description BACKGROUND: We surveyed HIV patients with late-stage disease in southern Vietnam to determine if barriers to access and service quality resulted in late HIV testing and delays from initial diagnosis to entry into HIV care. METHODOLOGY: 196 adult patients at public HIV clinics with CD4 counts less than 250 cells/mm3 completed a standardized questionnaire. We used multivariate analysis to determine risk factors for delayed entry into care, defined as >3 months time from diagnosis to registration. RESULTS: Common reasons for delayed testing were feeling healthy (71%), fear of stigma and discrimination in the community (43%), time conflicts with work or school (31%), did not want to know if infected (30%), and fear of lack of confidentiality (27%). Forty-five percent of participants delayed entry into care with a median CD4 count of 65 cells/mm3. The most common reasons for delayed entry were feeling healthy (51%), fear of stigma and discrimination in the community (41%), time conflicts with work or school (33%), and fear of lack of confidentiality (26%). Independent predictors for delayed entry were feeling healthy (aOR 3.7, 95% CI 1.5–9.1), first positive HIV test at other site (aOR 2.9, CI 1.2–7.1), history of injection drug use (IDU) (aOR 2.9, 95% CI 1.1–7.9), work/school conflicts (aOR 4.3, 95% CI 1.7–10.8), prior registration at another clinic (aOR 77.4, 95% CI 8.6–697), detention or imprisonment (aOR 10.3, 95% CI 1.8–58.2), and perceived distance to clinic (aOR 3.7, 95% CI 1.0–13.7). CONCLUSION: Delayed entry into HIV care in Vietnam is common and poses a significant challenge to preventing AIDS and opportunistic infections, decreasing mortality, and reducing HIV transmission. Improved linkages between testing and care are needed, particularly for patients who feel healthy, as well as incarcerated and drug-using populations who may face structural and social barriers to accessing care.
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spelling pubmed-41996032014-10-21 Risk Factors for Delayed Entrance into Care after Diagnosis among Patients with Late-Stage HIV Disease in Southern Vietnam Rangarajan, Suresh Tram, Hoang Nguyen Bao Todd, Catherine S. Thinh, Tran Hung, Van Hieu, Pham Thanh Hanh, Tran My Chau, Khong Minh Lam, Nguyen Danh Hung, Pham Tri West, Gary Colby, Donn PLoS One Research Article BACKGROUND: We surveyed HIV patients with late-stage disease in southern Vietnam to determine if barriers to access and service quality resulted in late HIV testing and delays from initial diagnosis to entry into HIV care. METHODOLOGY: 196 adult patients at public HIV clinics with CD4 counts less than 250 cells/mm3 completed a standardized questionnaire. We used multivariate analysis to determine risk factors for delayed entry into care, defined as >3 months time from diagnosis to registration. RESULTS: Common reasons for delayed testing were feeling healthy (71%), fear of stigma and discrimination in the community (43%), time conflicts with work or school (31%), did not want to know if infected (30%), and fear of lack of confidentiality (27%). Forty-five percent of participants delayed entry into care with a median CD4 count of 65 cells/mm3. The most common reasons for delayed entry were feeling healthy (51%), fear of stigma and discrimination in the community (41%), time conflicts with work or school (33%), and fear of lack of confidentiality (26%). Independent predictors for delayed entry were feeling healthy (aOR 3.7, 95% CI 1.5–9.1), first positive HIV test at other site (aOR 2.9, CI 1.2–7.1), history of injection drug use (IDU) (aOR 2.9, 95% CI 1.1–7.9), work/school conflicts (aOR 4.3, 95% CI 1.7–10.8), prior registration at another clinic (aOR 77.4, 95% CI 8.6–697), detention or imprisonment (aOR 10.3, 95% CI 1.8–58.2), and perceived distance to clinic (aOR 3.7, 95% CI 1.0–13.7). CONCLUSION: Delayed entry into HIV care in Vietnam is common and poses a significant challenge to preventing AIDS and opportunistic infections, decreasing mortality, and reducing HIV transmission. Improved linkages between testing and care are needed, particularly for patients who feel healthy, as well as incarcerated and drug-using populations who may face structural and social barriers to accessing care. Public Library of Science 2014-10-16 /pmc/articles/PMC4199603/ /pubmed/25330196 http://dx.doi.org/10.1371/journal.pone.0108939 Text en © 2014 Rangarajan 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
Rangarajan, Suresh
Tram, Hoang Nguyen Bao
Todd, Catherine S.
Thinh, Tran
Hung, Van
Hieu, Pham Thanh
Hanh, Tran My
Chau, Khong Minh
Lam, Nguyen Danh
Hung, Pham Tri
West, Gary
Colby, Donn
Risk Factors for Delayed Entrance into Care after Diagnosis among Patients with Late-Stage HIV Disease in Southern Vietnam
title Risk Factors for Delayed Entrance into Care after Diagnosis among Patients with Late-Stage HIV Disease in Southern Vietnam
title_full Risk Factors for Delayed Entrance into Care after Diagnosis among Patients with Late-Stage HIV Disease in Southern Vietnam
title_fullStr Risk Factors for Delayed Entrance into Care after Diagnosis among Patients with Late-Stage HIV Disease in Southern Vietnam
title_full_unstemmed Risk Factors for Delayed Entrance into Care after Diagnosis among Patients with Late-Stage HIV Disease in Southern Vietnam
title_short Risk Factors for Delayed Entrance into Care after Diagnosis among Patients with Late-Stage HIV Disease in Southern Vietnam
title_sort risk factors for delayed entrance into care after diagnosis among patients with late-stage hiv disease in southern vietnam
topic Research Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4199603/
https://www.ncbi.nlm.nih.gov/pubmed/25330196
http://dx.doi.org/10.1371/journal.pone.0108939
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