title: Risk factors for late-stage HIV disease presentation at initial HIV diagnosis in Durban, South Africa.
abstract: 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.
authors: Division of Infectious Diseases, Massachusetts General Hospital, Boston, Massachusetts, United States of America. pdrain@partners.org
authors: Paul K
authors: PK
authors: Drain
authors: Elena
authors: E
authors: Losina
authors: Gary
authors: G
authors: Parker
authors: Janet
authors: J
authors: Giddy
authors: Douglas
authors: D
authors: Ross
authors: Jeffrey N
authors: JN
authors: Katz
authors: Sharon M
authors: SM
authors: Coleman
authors: Laura M
authors: LM
authors: Bogart
authors: Kenneth A
authors: KA
authors: Freedberg
authors: Rochelle P
authors: RP
authors: Walensky
authors: Ingrid V
authors: IV
authors: Bassett
mesh_terms: D015496:CD4-Positive T-Lymphocytes / Q000276:immunology*; D002452:Cell Count; D018450:Disease Progression; D005843:Geography; D015658:HIV Infections / Q000175:diagnosis / Q000453:epidemiology* / Q000276:immunology*; D006801:Humans; D016017:Odds Ratio; D011446:Prospective Studies; D012044:Regression Analysis; D012307:Risk Factors; D012959:Socioeconomic Factors; D013019:South Africa / Q000453:epidemiology
references: Arch Intern Med. 1998 Apr 13;158(7):734-40
references: 9554679
references: AIDS Care. 2012;24(6):728-36
references: 22150119
references: AIDS. 2002 Sep 27;16(14):1945-51
references: 12351955
references: J Int AIDS Soc. 2010 Mar 06;13:8
references: 20205930
references: PLoS One. 2010 Mar 04;5(3):e9538
references: 20209059
references: BMC Public Health. 2007 Apr 25;7:63
references: 17459154
references: JAMA. 2001 Mar 21;285(11):1466-74
references: 11255423
references: J Acquir Immune Defic Syndr. 2008 Apr 15;47(5):597-606
references: 18285714
references: Int J STD AIDS. 2005 Jan;16(1):38-41
references: 15705271
references: HIV Med. 2004 Mar;5(2):93-8
references: 15012648
references: AIDS. 2010 Nov 13;24(17):2645-50
references: 20980868
references: PLoS Med. 2011 Jul;8(7):e1001056
references: 21811403
references: Am J Psychiatry. 2001 May;158(5):725-30
references: 11329393
references: AIDS. 2010 Jan;24 Suppl 1:S37-44
references: 20023438
references: AIDS Patient Care STDS. 2010 Nov;24(11):735-41
references: 21067357
references: Trop Med Int Health. 2010 Jun;15 Suppl 1:48-54
references: 20586960
references: Health Econ. 1993 Oct;2(3):217-27
references: 8275167
references: AIDS. 2012 Jan 2;26(1):67-75
references: 21904186
references: AIDS. 2004 Jan 1;18 Suppl 1:S49-59
references: 15075498
references: Lancet. 2007 Sep 8;370(9590):859-77
references: 17804063
references: Lancet. 2002 Jul 13;360(9327):119-29
references: 12126821
references: AIDS. 2004 Nov 5;18(16):2145-51
references: 15577647
references: AIDS Res Ther. 2011 Feb 28;8:8
references: 21356115
references: Soc Sci Med. 1991;32(6):705-14
references: 2035047
references: AIDS. 2008 Apr 23;22(7):873-82
references: 18427206
references: Arch Gen Psychiatry. 1994 Jan;51(1):39-49
references: 8279928
references: Clin Infect Dis. 2012 Jan 15;54(2):275-81
references: 22156847
references: J Acquir Immune Defic Syndr. 2009 Oct 1;52(2):280-9
references: 19521248
references: Ann Intern Med. 2011 Aug 16;155(4):209-16
references: 21768555
references: AIDS Behav. 2012 Nov;16(8):2226-35
references: 22451351
references: Clin Infect Dis. 2009 Oct 1;49(7):1096-102
references: 19725790
references: PLoS Med. 2006 Jul;3(7):e261
references: 16834458
references: AIDS Patient Care STDS. 2009 Oct;23(10):867-75
references: 19803678
references: Ethiop Med J. 2006 Jul;44(3):237-44
references: 17447389
references: Clin Infect Dis. 2012 Jan 15;54(2):282-4
references: 22156849
references: PLoS One. 2011;6(7):e21794
references: 21750732
references: AIDS. 2008 Oct 1;22(15):1897-908
references: 18784453
references: PLoS One. 2006 Dec 27;1:e121
references: 17205125
references: Med Care. 1999 Dec;37(12):1270-81
references: 10599608
references: AIDS. 2009 Feb 20;23(4):525-30
references: 19182676
references: PLoS One. 2010 Apr 28;5(4):e10340
references: 20442769
references: Lancet. 2006 Oct 7;368(9543):1254-9
references: 17027731
references: Lancet. 2010 Aug 7;376(9739):449-57
references: 20638120