title: Factors associated with late presentation for HIV/AIDS care in Harare City, Zimbabwe, 2015.
abstract: Despite widespread awareness and publicity concerning Human Immunodeficiency Virus (HIV) care and advances in treatment, many patients still present late in their HIV disease. Preliminary review of the Antiretroviral Therapy (ART) registers at Wilkins and Beatrice Road Hospitals, both located in Harare, indicated that 67 and 71 % of patients enrolled into HIV/AIDS care presented late with baseline CD4 of <200 cells/uL and/or WHO stage 3 and 4 respectively. We therefore sought to explore factors associated with late presentation in Harare City.
  
  
  
  We conducted a 1:1 unmatched case control study where a case was an HIV positive individual (>18 years) with a baseline CD4 of <200/uL or who had WHO clinical stage 3 or 4 at first presentation to OI/ART centres in 2014 and; a control was HIV positive individual (>18 years) who had a baseline CD4 of >200/uL or WHO clinical stage 1 or 2 at first presentation in 2014. Written informed consent was obtained from all study participants.
  
  
  
  A total of 268 participants were recruited (134 cases and 134 controls). Independent risk factors for late presentation for HIV/AIDS care were illness being reason for test (Adjusted Odds Ratio [aOR] =7.68, 95 % CI = 4.08, 14.75); Being male (aOR = 2.84, 95 % CI = 1.50, 5.40) and; experienced HIV stigma (aOR = 2.99, 95 % CI = 1.54, 5.79). Independent protective factors were receiving information on HIV (aOR = 0.37, 95 % CI = 0.18, 0.78) and earning more than US$250 per month (aOR = 0.32, 95 % CI = 0.76, 0.67). Median duration between first reported HIV positive test result and enrolment into pre-ART care was 2 days (Q1 = 1 day; Q3 = 30 days) among cases and 30 days (Q1 = 3 days; Q3 = 75 days) among controls.
  
  
  
  Late presentation for HIV/AIDS care in Harare City was a result of factors that relate to the patient's sex, reason for getting a test, receiving HIV related information, experiencing stigma and monthly income. Based on this evidence we recommended targeted interventions to optimize early access to testing and enrolment into care.
authors.affiliation: Department of Community Medicine, University of Zimbabwe, Harare, Zimbabwe.
authors.forename: Howard
authors.initials: H
authors.lastname: Nyika
authors.affiliation: Ministry of Health and Child Care, AIDS and TB Unit, Harare, Zimbabwe.
authors.forename: Owen
authors.initials: O
authors.lastname: Mugurungi
authors.affiliation: Department of Community Medicine, University of Zimbabwe, Harare, Zimbabwe.
authors.forename: Gerald
authors.initials: G
authors.lastname: Shambira
authors.affiliation: Department of Community Medicine, University of Zimbabwe, Harare, Zimbabwe.
authors.forename: Notion Tafara
authors.initials: NT
authors.lastname: Gombe
authors.affiliation: Department of Community Medicine, University of Zimbabwe, Harare, Zimbabwe. bangured@yahoo.com.
authors.forename: Donewell
authors.initials: D
authors.lastname: Bangure
authors.affiliation: Department of Community Medicine, University of Zimbabwe, Harare, Zimbabwe.
authors.forename: More
authors.initials: M
authors.lastname: Mungati
authors.affiliation: Department of Community Medicine, University of Zimbabwe, Harare, Zimbabwe.
authors.forename: Mufuta
authors.initials: M
authors.lastname: Tshimanga
mesh_terms: D000163:Acquired Immunodeficiency Syndrome / Q000175:diagnosis* / Q000523:psychology*; D000328:Adult; D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D016022:Case-Control Studies; D057210:Delayed Diagnosis / Q000706:statistics & numerical data*; D005260:Female; D015658:HIV Infections / Q000175:diagnosis* / Q000523:psychology*; D006801:Humans; D008297:Male; D008875:Middle Aged; D016017:Odds Ratio; D010342:Patient Acceptance of Health Care / Q000523:psychology* / Q000706:statistics & numerical data*; D012307:Risk Factors; D012737:Sex Factors; D057545:Social Stigma; D055815:Young Adult; D015030:Zimbabwe
keywords: HIV/AIDS; Harare City; Late presentation; Zimbabwe