title: Advanced HIV Disease at Enrolment in HIV Care: Trends and Associated Factors over a Ten Year Period in Cambodia.
abstract: BACKGROUND
  Early HIV diagnosis and enrolment in care is needed to achieve early antiretroviral treatment (ART) initiation. Studies on HIV disease stage at enrolment in care from Asian countries are limited. We evaluated trends in and factors associated with late HIV disease presentation over a ten-year period in the largest ART center in Cambodia.
  
  
  METHODS
  We conducted a retrospective analysis of program data including all ARV-naïve adults (> 18 years old) enrolling into HIV care from March 2003-December 2013 in a non-governmental hospital in Phnom Penh, Cambodia. We calculated the proportion presenting with advanced stage HIV disease (WHO clinical stage IV or CD4 cell count <100 cells/μL) and the probability of ART initiation by six months after enrolment. Factors associated with late presentation were determined using multivariate logistic regression.
  
  
  RESULTS
  From 2003-2013, a total of 5642 HIV-infected patients enrolled in HIV care. The proportion of late presenters decreased from 67% in 2003 to 44% in 2009 and 41% in 2013; a temporary increase to 52% occurred in 2011 coinciding with logistical/budgetary constraints at the national program level. Median CD4 counts increased from 32 cells/μL (IQR 11-127) in 2003 to 239 cells/μL (IQR 63-291) in 2013. Older age and male sex were associated with late presentation across the ten-year period. The probability of ART initiation by six months after enrolment increased from 22.6% in 2003-2006 to 79.9% in 2011-2013.
  
  
  CONCLUSIONS
  Although a gradual improvement was observed over time, a large proportion of patients still enroll late, particularly older or male patients. Interventions to achieve early HIV testing and efficient linkage to care are warranted.
authors.affiliation: Sihanouk Hospital Center of HOPE, Phnom Penh, Cambodia.
authors.forename: Reaksmey
authors.initials: R
authors.lastname: Pe
authors.affiliation: Sihanouk Hospital Center of HOPE, Phnom Penh, Cambodia.
authors.forename: Bopha
authors.initials: B
authors.lastname: Chim
authors.affiliation: Sihanouk Hospital Center of HOPE, Phnom Penh, Cambodia.
authors.forename: Sopheak
authors.initials: S
authors.lastname: Thai
authors.affiliation: Institute of Tropical Medicine, Antwerp, Belgium.
authors.forename: Lutgarde
authors.initials: L
authors.lastname: Lynen
authors.affiliation: Sihanouk Hospital Center of HOPE, Phnom Penh, Cambodia.|Institute of Tropical Medicine, Antwerp, Belgium.
authors.forename: Johan
authors.initials: J
authors.lastname: van Griensven
mesh_terms: D000328:Adult; D023241:Antiretroviral Therapy, Highly Active; D018791:CD4 Lymphocyte Count; D002160:Cambodia / Q000453:epidemiology; D003695:Delivery of Health Care; D018450:Disease Progression; D005260:Female; D015658:HIV Infections / Q000175:diagnosis / Q000188:drug therapy / Q000453:epidemiology* / Q000276:immunology / Q000821:virology; D006801:Humans; D008297:Male; D017063:Outcome Assessment, Health Care; D015995:Prevalence; D012189:Retrospective Studies; D012720:Severity of Illness Index