title: Factors Associated with Late Engagement to HIV Care in Western Kenya: A Cross-Sectional Study.
abstract: Late presentation of patients contributes significantly to the high mortality reported in HIV -care and treatment programs in sub-Saharan Africa.
  
  
  
  A cross-sectional study was conducted to assess factors associated with late engagement to HIV care at the Academic Model Providing Access to Healthcare in western Kenya. Late engagement was defined as baseline CD4 ≤100 cells/mm3.
  
  
  
  Of the 10 533 participants included in the analysis, 67% were female and mean age was 36.7 years. Overall, 23% of the participants presented late. Factors associated with late engagement included male gender (adjusted odds ratio [AOR]: 1.54, 95% confidence interval [CI]: 1.35-1.75), older age (AOR: 1.62, 95% CI: 1.02-2.56), and longer travel time to clinic (AOR: 1.18, 95% CI: 1.04-1.34).
  
  
  
  Nearly one-quarter of HIV-infected patients in our setting present with advanced immune suppression at initial encounter. Being male, older age, and living further away from clinic are associated with late engagement to care.
authors.affiliation: Academic Model Providing Access to Healthcare (AMPATH), Eldoret, Kenya ckwobah@yahoo.com.|Department of Medicine, College of Health Sciences, School of Medicine, Moi University, Eldoret, Kenya.
authors.forename: Charles Meja
authors.initials: CM
authors.lastname: Kwobah
authors.affiliation: Academic Model Providing Access to Healthcare (AMPATH), Eldoret, Kenya.|Department of Medicine, College of Health Sciences, School of Medicine, Moi University, Eldoret, Kenya.|Department of Medicine, Indiana University School of Medicine, Indianapolis, IN, USA.|University of Toronto, Dalla Lana School of Public Health, Toronto, Canada.
authors.forename: Paula
authors.initials: P
authors.lastname: Braitstein
authors.affiliation: Academic Model Providing Access to Healthcare (AMPATH), Eldoret, Kenya.
authors.forename: Julius K
authors.initials: JK
authors.lastname: Koech
authors.affiliation: Academic Model Providing Access to Healthcare (AMPATH), Eldoret, Kenya.
authors.forename: Gilbert
authors.initials: G
authors.lastname: Simiyu
authors.affiliation: Academic Model Providing Access to Healthcare (AMPATH), Eldoret, Kenya.|Department of Behavioral Sciences, College of Health Sciences, School of Medicine, Moi University, Eldoret, Kenya.
authors.forename: Ann W
authors.initials: AW
authors.lastname: Mwangi
authors.affiliation: Academic Model Providing Access to Healthcare (AMPATH), Eldoret, Kenya.|Department of Medicine, Indiana University School of Medicine, Indianapolis, IN, USA.
authors.forename: Kara
authors.initials: K
authors.lastname: Wools-Kaloustian
authors.affiliation: Academic Model Providing Access to Healthcare (AMPATH), Eldoret, Kenya.|Department of Medicine, College of Health Sciences, School of Medicine, Moi University, Eldoret, Kenya.
authors.forename: Abraham M
authors.initials: AM
authors.lastname: Siika
mesh_terms: D000328:Adult; D018791:CD4 Lymphocyte Count; D003430:Cross-Sectional Studies; D005260:Female; D015658:HIV Infections / Q000188:drug therapy / Q000453:epidemiology* / Q000276:immunology; D006801:Humans; D007630:Kenya / Q000453:epidemiology; D008297:Male; D008875:Middle Aged; D061665:Time-to-Treatment / Q000706:statistics & numerical data*; D055815:Young Adult
keywords: HIV; advanced immune suppression; late presentation