title: Patients who present late to HIV care and associated risk factors in Nigeria.
abstract: OBJECTIVE
  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/μL or AIDS-defining illness) and AHD (CD4 count < 200 cells/μL 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.
authors.affiliation: Department of Family Medicine, University of Jos, Jos, Nigeria; AIDS Prevention Initiative Nigeria Plus, Jos University Teaching Hospital, Jos, Nigeria.
authors.forename: P A
authors.initials: PA
authors.lastname: Agaba
authors.forename: S T
authors.initials: ST
authors.lastname: Meloni
authors.forename: H M
authors.initials: HM
authors.lastname: Sule
authors.forename: O O
authors.initials: OO
authors.lastname: Agbaji
authors.forename: P N
authors.initials: PN
authors.lastname: Ekeh
authors.forename: G C
authors.initials: GC
authors.lastname: Job
authors.forename: N
authors.initials: N
authors.lastname: Nyango
authors.forename: P O
authors.initials: PO
authors.lastname: Ugoagwu
authors.forename: G E
authors.initials: GE
authors.lastname: Imade
authors.forename: J A
authors.initials: JA
authors.lastname: Idoko
authors.forename: P J
authors.initials: PJ
authors.lastname: Kanki
mesh_terms: D015492:AIDS Serodiagnosis / Q000706:statistics & numerical data*; D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D018791:CD4 Lymphocyte Count; D005260:Female; D015658:HIV Infections / Q000097:blood / Q000175:diagnosis*; D006801:Humans; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D009549:Nigeria; D010342:Patient Acceptance of Health Care / Q000706:statistics & numerical data*; D012189:Retrospective Studies; D012307:Risk Factors; D012959:Socioeconomic Factors; D013997:Time Factors; D055815:Young Adult
keywords: HIV; Nigeria; advanced HIV disease; late presentation; risk factors