title: Mixed method approach for determining factors associated with late presentation to HIV/AIDS care in southern India.
abstract: BACKGROUND
  Early diagnosis and treatment of human Immunodeficiency virus (HIV) is not only beneficial for the people living with HIV/acquired immunodeficiency syndrome (AIDS) (PLHA) but for the public and society as well. The study was aimed to identify the factors associated with late presentation to HIV/AIDS care.
  
  
  METHODS
  A facility-based unmatched case-control (1:1) study along with in-depth qualitative assessment was conducted at an ART Plus center at a district hospital, Udupi, southern India. A sample of 320 HIV patients (160 cases and 160 controls) was selected randomly between February and July 2014. Information regarding the patients were collected using an interviewer-administered semi-structured questionnaire. The qualitative component was assessed by in-depth interviews of 4 health professionals and 12 HIV-positive patients who were late for HIV care. The quantitative data were analyzed using Statistical Package for the Social Sciences (SPSS) version 15.0. The technique of thematic analysis was adopted for the analysis of qualitative data.
  
  
  RESULTS
  HIV-positive individuals who lived with families [odds ratio (OR) = 5.11], the patients having non-AIDS comorbidities [OR= 2.19, 95% confidence interval (CI): 1.09-4.40], the patients who perceived fear of losing family [OR = 5.00, 95% CI: 2.17-11.49], the patients who perceived fear that their status will be ruined in the community [OR= 2.00, 95% CI: 1.01-3.97], the patients who perceived fear of side effects of ART medications [OR = 4.3, 95% CI: 2.65-11.33], the patients who perceived fear of losing confidentiality [OR = 4.94, 95% CI: 2.54-9.59], the patients those who lack information available on government services [OR = 4.12, 95% CI: 2.127-8.005], and the patients who consumed alcohol [OR= 3.52, 95% CI: 1.83-6.77] were found to be independently associated with the late presentation to HIV/AIDS care after adjusting for all known confounders in a multivariable analysis. The qualitative summary showed that the perceived HIV stigma, inadequate health education, lack of awareness on available government services, psychological problems, alcohol use, asymptomatic conditions, and financial problems are major barriers to access care early for the late presenters.
  
  
  CONCLUSIONS
  The identified factors can be utilized for the formulation of policies and interventions by promoting early diagnoses and addressing special concerns such as stigma, disclosure, health education, and awareness.
authors.affiliation: Department of Public Health, Manipal University, Manipal, Karnataka, India.
authors.forename: U N
authors.initials: UN
authors.lastname: Yadav
authors.affiliation: Department of Public Health, Manipal University, Manipal, Karnataka, India.
authors.forename: V
authors.initials: V
authors.lastname: Chandrasekharan
authors.affiliation: Department of Statistics, Manipal University, Manipal, Karnataka, India.
authors.forename: V
authors.initials: V
authors.lastname: Guddattu
authors.affiliation: CAPHRI School of Public Health and Preventive Medicine, Maastricht University, Netherlands.
authors.forename: Jrjh
authors.initials: J
authors.lastname: Gruiskens
mesh_terms: D015492:AIDS Serodiagnosis / Q000706:statistics & numerical data; D000328:Adult; D016022:Case-Control Studies; D057210:Delayed Diagnosis; D005239:Fear; D005260:Female; D015658:HIV Infections / Q000175:diagnosis* / Q000523:psychology*; D007722:Health Knowledge, Attitudes, Practice; D006297:Health Services Accessibility; D006801:Humans; D007194:India; D007407:Interviews as Topic; D008297:Male; D008875:Middle Aged; D036301:Qualitative Research; D057545:Social Stigma; D012959:Socioeconomic Factors; D011795:Surveys and Questionnaires