title: Delayed presentation and late testing for HIV: demographic and behavioral risk factors in a multicenter study in Italy.
abstract: Ensuring timely access to care for persons with HIV is an important public health goal. To identify factors associated with delayed presentation to medical care after testing HIV-positive or with late HIV testing, we studied 968 patients at their first HIV care visit, enrolled in a multicenter study in Italy from 1997-2000. Patients completed a questionnaire on HIV-testing history, sexual behavior, and drug use behavior. Delayed presenters were patients with >6 months between their first HIV-positive test and presentation for HIV care; late testers were patients with CD4 count < 200 /mm or clinically defined AIDS at their first HIV-positive test. Among the study patients, 255 (26.3%) were delayed presenters, and 280 (28.9%) were late testers. In multinomial logistic regression analysis, injection drug use significantly increased (odds ratio [OR]= 5.04) the probability of delayed presentation but reduced (OR = 0.55) the chance of late testing. A previous HIV-negative test was associated with a reduced risk of both delayed presentation (OR = 0.39) and late testing (OR = 0.36). Unemployment was positively associated with delayed presentation and increasing age with late testing, whereas HIV counseling at the time of first positive HIV test strongly (OR = 0.42) reduced the odds of delayed presentation. Interventions aimed at promoting timely access to care of HIV-infected persons should consider differentiated programs for delayed presentation and late testing.
authors.affiliation: Dipartimento di Epidemiologia, INMI Lazzaro Spallanzani, Roma, Italy. girardi@inmi.it
authors.forename: Enrico
authors.initials: E
authors.lastname: Girardi
authors.forename: Maria Stella
authors.initials: MS
authors.lastname: Aloisi
authors.forename: Claudio
authors.initials: C
authors.lastname: Arici
authors.forename: Patrizio
authors.initials: P
authors.lastname: Pezzotti
authors.forename: Diego
authors.initials: D
authors.lastname: Serraino
authors.forename: Roberta
authors.initials: R
authors.lastname: Balzano
authors.forename: Gianmarco
authors.initials: G
authors.lastname: Vigevani
authors.forename: Francesco
authors.initials: F
authors.lastname: Alberici
authors.forename: Maria
authors.initials: M
authors.lastname: Ursitti
authors.forename: Margherita
authors.initials: M
authors.lastname: D'Alessandro
authors.forename: Antonella
authors.initials: A
authors.lastname: d'Arminio Monforte
authors.forename: Giuseppe
authors.initials: G
authors.lastname: Ippolito
mesh_terms: D000328:Adult; D000367:Age Factors; D015331:Cohort Studies; D005260:Female; D015658:HIV Infections / Q000453:epidemiology*; D006801:Humans; D007558:Italy / Q000453:epidemiology; D008297:Male; D008875:Middle Aged; D016017:Odds Ratio; D010342:Patient Acceptance of Health Care / Q000706:statistics & numerical data*; D011159:Population Surveillance; D012044:Regression Analysis; D012307:Risk Factors; D012725:Sexual Behavior; D015819:Substance Abuse, Intravenous; D011795:Surveys and Questionnaires; D014478:Unemployment