title: Predictors of Late HIV Diagnosis among Adult People Living with HIV/AIDS Who Undertake an Initial CD4 T Cell Evaluation, Northern Ethiopia: A Case-Control Study.
abstract: BACKGROUND
  Early HIV testing and timely initiation of ART is critical for the improved quality of life of PLWHIV. Having identified a higher rates of Late HIV diagnosis, this study was aimed to determine Determinants of late diagnosis of HIV among adult HIV patients in Bahir Dar, Northern Ethiopia.
  
  
  METHODS
  A case control study was conducted between January 2010 to December 2011 at Bahir Dar Felege Hiwot Referral Hospital. The study subjects consisted of 267 cases and 267 controls. Cases were adult people living with HIV/AIDS whose initial CD4 T cell count was < 200/μl of blood. Controls were those with a CD4 T cell count of greater than 200/ μl. Trained staff nurses were involved in data collection using a semi-structured questionnaire. Data was entered and analyzed using SPSS version 20. Descriptive statistics and Binary logistic regression were performed.
  
  
  RESULTS
  Subjects who hold a certificate and above (AOR = 0.26; 95% CI = 0.13. 0.54), being initiated by friends, families and other socials to undertake HIV testing (AOR = 0.65; 95% CI = 0.29, 1.48), who reported a medium and high knowledge score about HIV/AIDS and who undertake HIV testing while visiting a clinic for ANC (AOR = 0.40; 95% CI = 0.19, 0.83) were less likely to be diagnosed late. Subjects who undertake HIV testing due to providers' initiation (AOR = 1.70; 95%CI = 1.08, 2.68), who reported a medium internalized stigma (AOR = 4.94; 95% CI = 3.13, 7.80) and who reported a high internalized stigma score towards HIV/AIDS (AOR = 16.64; 95% CI = 8.29, 33.4) had a high odds of being diagnosed late compared to their counterparts.
  
  
  CONCLUSIONS
  Internalized stigma, low knowledge level about HIV/AIDS, not to have attended formal education and failure to undertake HIV testing by own initiation were significant determinant factors associated with Late HIV diagnosis. Education about HIV/AIDS, promotion of general education, and encouraging people to motivate their social mates to undertake HIV testing are highly recommended.
authors.affiliation: Department of Public Health, College of Health Sciences, Bahir Dar University, Bahir Dar, Ethiopia.
authors.forename: Melkamu Bedimo
authors.initials: MB
authors.lastname: Beyene
authors.affiliation: Department of Microbiology, Immunology and Parasitology, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia.
authors.forename: Habtamu Bedimo
authors.initials: HB
authors.lastname: Beyene
mesh_terms: D000328:Adult; D018791:CD4 Lymphocyte Count; D015496:CD4-Positive T-Lymphocytes; D016022:Case-Control Studies; D057210:Delayed Diagnosis; D005002:Ethiopia; D005260:Female; D015658:HIV Infections / Q000175:diagnosis* / Q000276:immunology; D006801:Humans; D008297:Male