title: Delayed entry to care by men with HIV infection in Kumasi, Ghana.
abstract: BACKGROUND
  In resource-limited settings, men may face considerable barriers to accessing HIV care as early interventions tend to focus on antenatal care settings.
  
  
  METHODS
  We performed a retrospective chart review of all adult patients referred to Komfo Anokye Teaching Hospital HIV clinic in Kumasi, Ghana in 2011 to identify the differences in clinical and demographic variables by gender at presentation to care using two-sample t tests with adjusted variance and Wilcox rank sum tests for continuous variables and Pearson chi-squared tests for categorical variables. We also compared differences in clinical and demographic variables among men stratified by CD4 count at initiation of care in order to identify variables associated with later entry to care.
  
  
  RESULTS
  Demographically, men were more likely to be older (men age 42 vs. 37, p<0.01), have a greater number of dependent children (1.8 v. 1.5, p = 0.04), to be living with or married to their partner (65.4% vs. 49.0%, p<0.01), and to have a higher level of education (tertiary education, 45.8% vs. 25.4%, p<0.01) than women. Clinically, men were more likely to have a lower CD4 count at entry to care (260 v. 311 cells/µL, p<0.01), to report clinical symptoms to the nurse during intake (p<0.01), and to have any history of alcohol use (p<0.01).
  
  
  CONCLUSIONS
  Men in Ghana are accessing treatment at a later stage of their disease than women. Efforts to test and link men to care early should be intensified.
authors: Warren Alpert Medical School, Brown University, Providence, RI, USA.
authors: Natasha
authors: N
authors: Kumar
authors: Department of Medicine, The Miriam Hospital, Providence, RI USA.
authors: Rebecca
authors: R
authors: Reece
authors: Komfo Anokye Teaching Hospital, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana.
authors: Betty
authors: B
authors: Norman
authors: Warren Alpert Medical School, Brown University, Providence, RI, USA; Department of Medicine, The Miriam Hospital, Providence, RI USA.
authors: Awewura
authors: A
authors: Kwara
authors: Warren Alpert Medical School, Brown University, Providence, RI, USA; Department of Medicine, The Miriam Hospital, Providence, RI USA.
authors: Timothy
authors: T
authors: Flanigan
authors: Warren Alpert Medical School, Brown University, Providence, RI, USA; Department of Medicine, The Miriam Hospital, Providence, RI USA.
authors: Aadia
authors: A
authors: Rana
mesh_terms: D000328:Adult; D000367:Age Factors; D018791:CD4 Lymphocyte Count; D005260:Female; D005869:Ghana; D015658:HIV Infections / Q000628:therapy*; D006297:Health Services Accessibility / Q000706:statistics & numerical data*; D006784:Hospitals, Teaching; D006801:Humans; D008297:Male; D008875:Middle Aged; D010342:Patient Acceptance of Health Care / Q000706:statistics & numerical data*; D012189:Retrospective Studies; D012737:Sex Factors; D013997:Time Factors
keywords: Gender disparities; Ghana; HIV; access to care; entry to care; men