title: Reasons for late presentation to HIV care in Switzerland.
abstract: BACKGROUND
  Late presentation to HIV care leads to increased morbidity and mortality. We explored risk factors and reasons for late HIV testing and presentation to care in the nationally representative Swiss HIV Cohort Study (SHCS).
  
  
  METHODS
  Adult patients enrolled in the SHCS between July 2009 and June 2012 were included. An initial CD4 count <350 cells/µl or an AIDS-defining illness defined late presentation. Demographic and behavioural characteristics of late presenters (LPs) were compared with those of non-late presenters (NLPs). Information on self-reported, individual barriers to HIV testing and care were obtained during face-to-face interviews.
  
  
  RESULTS
  Of 1366 patients included, 680 (49.8%) were LPs. Seventy-two percent of eligible patients took part in the survey. LPs were more likely to be female (p<0.001) or from sub-Saharan Africa (p<0.001) and less likely to be highly educated (p=0.002) or men who have sex with men (p<0.001). LPs were more likely to have their first HIV test following a doctor's suggestion (p=0.01), and NLPs in the context of a regular check-up (p=0.02) or after a specific risk situation (p<0.001). The main reasons for late HIV testing were "did not feel at risk" (72%), "did not feel ill" (65%) and "did not know the symptoms of HIV" (51%). Seventy-one percent of the participants were symptomatic during the year preceding HIV diagnosis and the majority consulted a physician for these symptoms.
  
  
  CONCLUSIONS
  In Switzerland, late presentation to care is driven by late HIV testing due to low risk perception and lack of awareness about HIV. Tailored HIV testing strategies and enhanced provider-initiated testing are urgently needed.
authors.affiliation: Department of Infectious Diseases, Bern University Hospital, University of Bern, Bern, Switzerland.
authors.forename: Anna
authors.initials: A
authors.lastname: Hachfeld
authors.affiliation: Division of Infectious Diseases and Hospital Epidemiology, University Hospital Zurich, University of Zurich, Zurich, Switzerland.
authors.forename: Bruno
authors.initials: B
authors.lastname: Ledergerber
authors.affiliation: Division of Infectious Diseases and Hospital Epidemiology, University Hospital Lausanne, Lausanne, Switzerland.
authors.forename: Katharine
authors.initials: K
authors.lastname: Darling
authors.affiliation: Division of Infectious Diseases and Hospital Epidemiology, University Hospital Zurich, University of Zurich, Zurich, Switzerland.
authors.forename: Rainer
authors.initials: R
authors.lastname: Weber
authors.affiliation: Division of Infectious Diseases and Hospital Epidemiology, University Hospital Geneva, Geneva, Switzerland.
authors.forename: Alexandra
authors.initials: A
authors.lastname: Calmy
authors.affiliation: Division of Infectious Diseases and Hospital Epidemiology, University Hospital Basel, University of Basel, Basel, Switzerland.
authors.forename: Manuel
authors.initials: M
authors.lastname: Battegay
authors.affiliation: Cantonal Hospital, St. Gallen, Switzerland.
authors.forename: Kiyoshi
authors.initials: K
authors.lastname: Sugimoto
authors.affiliation: Regional Hospital, Lugano, Switzerland.
authors.forename: Caroline
authors.initials: C
authors.lastname: Di Benedetto
authors.affiliation: Cantonal Hospital Aargau, Aargau, Switzerland.
authors.forename: Christoph A
authors.initials: CA
authors.lastname: Fux
authors.affiliation: Cantonal Hospital Baselland, Bruderholz, University of Basel, Basel, Switzerland.
authors.forename: Philip E
authors.initials: PE
authors.lastname: Tarr
authors.affiliation: Division of Infectious Diseases and Hospital Epidemiology, University Hospital Zurich, University of Zurich, Zurich, Switzerland.
authors.forename: Roger
authors.initials: R
authors.lastname: Kouyos
authors.affiliation: Department of Infectious Diseases, Bern University Hospital, University of Bern, Bern, Switzerland; hansjakob.furrer@insel.ch.
authors.forename: Hansjakob
authors.initials: H
authors.lastname: Furrer
authors.affiliation: Department of Infectious Diseases, Bern University Hospital, University of Bern, Bern, Switzerland.|Institute of Social and Preventive Medicine, University of Bern, Switzerland; gilles.wandeler@ispm.unibe.ch.
authors.forename: Gilles
authors.initials: G
authors.lastname: Wandeler
mesh_terms: D000328:Adult; D018791:CD4 Lymphocyte Count; D015331:Cohort Studies; D005260:Female; D015658:HIV Infections / Q000175:diagnosis* / Q000276:immunology / Q000523:psychology; D006801:Humans; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D012307:Risk Factors; D013557:Switzerland
keywords: HIV infection; HIV testing; Switzerland; late presentation; self-reported reasons; success to care