title: Risk factors for delayed entrance into care after diagnosis among patients with late-stage HIV disease in southern Vietnam.
abstract: 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.
  
  
  METHODS
  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).
  
  
  CONCLUSIONS
  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.
authors.affiliation: FHI360 Vietnam, Ho Chi Minh City, Vietnam.
authors.forename: Suresh
authors.initials: S
authors.lastname: Rangarajan
authors.affiliation: FHI360 Vietnam, Ho Chi Minh City, Vietnam.
authors.forename: Hoang Nguyen Bao
authors.initials: HN
authors.lastname: Tram
authors.affiliation: Asia-Pacific Regional Office, FHI 360, Bangkok, Thailand.
authors.forename: Catherine S
authors.initials: CS
authors.lastname: Todd
authors.affiliation: Ho Chi Minh City Provincial AIDS Committee, Ho Chi Minh City, Vietnam.
authors.forename: Tran
authors.initials: T
authors.lastname: Thinh
authors.affiliation: Ho Chi Minh City Provincial AIDS Committee, Ho Chi Minh City, Vietnam.
authors.forename: Van
authors.initials: V
authors.lastname: Hung
authors.affiliation: District 8 Preventive Medicine Center, Ho Chi Minh City, Vietnam.
authors.forename: Pham Thanh
authors.initials: PT
authors.lastname: Hieu
authors.affiliation: An Giang Provincial AIDS Center, Long Xuyen, An Giang, Vietnam.
authors.forename: Tran My
authors.initials: TM
authors.lastname: Hanh
authors.affiliation: Tinh Bien Hospital, An Giang, Vietnam.
authors.forename: Khong Minh
authors.initials: KM
authors.lastname: Chau
authors.affiliation: Can Tho Provincial AIDS Center, Can Tho, Vietnam.
authors.forename: Nguyen Danh
authors.initials: ND
authors.lastname: Lam
authors.affiliation: Thot Not Outpatient Clinic, Can Tho, Vietnam.
authors.forename: Pham Tri
authors.initials: PT
authors.lastname: Hung
authors.affiliation: FHI360 Vietnam, Hanoi, Vietnam.
authors.forename: Gary
authors.initials: G
authors.lastname: West
authors.affiliation: Center for Applied Research on Men and Health, Ho Chi Minh City, Vietnam; SEARCH, Thai Red Cross AIDS Research Center, Bangkok, Thailand.
authors.forename: Donn
authors.initials: D
authors.lastname: Colby
mesh_terms: D000328:Adult; D005260:Female; D015658:HIV Infections / Q000175:diagnosis* / Q000453:epidemiology* / Q000401:mortality / Q000635:transmission; D006801:Humans; D008297:Male; D009313:National Health Programs; D010342:Patient Acceptance of Health Care / Q000706:statistics & numerical data*; D012307:Risk Factors; D013997:Time Factors; D014744:Vietnam / Q000453:epidemiology