title: Factors associated with late HIV diagnosis in North-East Scotland: a six-year retrospective study.
abstract: OBJECTIVE
  Late HIV diagnosis is associated with increased morbidity and mortality, increased risk of transmission, impaired response to antiretroviral therapy and increased health care costs. The aim of this study was to determine the factors associated with late HIV diagnosis in Grampian, North-East Scotland.
  
  
  METHODS
  A population based retrospective database analysis.
  
  
  METHODS
  All newly diagnosed HIV positive individuals in Grampian, North-East Scotland between 2009 and 2014 were included in the study. Participants were classified as having a late diagnosis if the CD4 cell count at presentation was less than 350 cells/mm3. Socio-economic and demographic factors were investigated in relation to outcome (late diagnosis) using Chi-squared and Mann-Whitney tests.
  
  
  RESULTS
  CD4 cell count results were available for 111 (89.5%) of the 124 newly diagnosed individuals during the study period. The prevalence of late diagnosis was 53.2% (n = 59). Those infected via heterosexual mode of transmission had a 2.83 times higher odds of late diagnosis (OR 2.83 [95% CI: 1.10-7.32]) than men who have sex with men (MSM) and those with no previous HIV testing had a 5.46 increased odds of late diagnosis (OR 5.46 [95% CI: 1.89-15.81]) compared to those who had previously been tested. Missed opportunities for HIV diagnosis were identified in 16.3% (n = 15) of participants.
  
  
  CONCLUSIONS
  Heterosexual individuals and those with no previous HIV testing were more likely to be diagnosed late. Targeted initiatives to increase perception of HIV risk and uptake of testing in these risk groups are recommended.
authors.affiliation: Institute of Applied Health Sciences, Postgraduate Education Department, University of Aberdeen, Aberdeen, Scotland, UK.
authors.forename: G
authors.initials: G
authors.lastname: Noble
authors.affiliation: Institute of Applied Health Sciences, Postgraduate Education Department, University of Aberdeen, Aberdeen, Scotland, UK; Public Health Department, NHS Grampian, Summerfield House, 2 Eday Road, Aberdeen, AB15 6RE, UK. Electronic address: emmanuel.okpo@nhs.net.
authors.forename: E
authors.initials: E
authors.lastname: Okpo
authors.affiliation: Aberdeen Royal Infirmary, Infectious Diseases Department, Emergency Care Centre, Aberdeen, UK.
authors.forename: I
authors.initials: I
authors.lastname: Tonna
authors.affiliation: Institute of Applied Health Sciences, Medical Statistics Department, University of Aberdeen, Aberdeen, Scotland, UK.
authors.forename: S
authors.initials: S
authors.lastname: Fielding
mesh_terms: D000293:Adolescent; D000328:Adult; D018791:CD4 Lymphocyte Count / Q000706:statistics & numerical data; D057210:Delayed Diagnosis / Q000706:statistics & numerical data*; D005260:Female; D015658:HIV Infections / Q000175:diagnosis*; D020010:Heterosexuality / Q000706:statistics & numerical data; D006801:Humans; D008297:Male; D008403:Mass Screening / Q000706:statistics & numerical data; D008875:Middle Aged; D012189:Retrospective Studies; D012307:Risk Factors; D012606:Scotland; D055815:Young Adult
keywords: CD4 cell count; HIV; Late diagnosis; Missed diagnosis