The prevalence and associated factors for delayed presentation for HIV care among tuberculosis/HIV co-infected patients in Southwest Ethiopia: a retrospective observational cohort.
BACKGROUND
A delay presentation for human immunodeficiency virus (HIV) patient's care (that is late engagement to HIV care due to delayed HIV testing or delayed linkage for HIV care after the diagnosis of HIV positive) is a critical step in the series of HIV patient care continuum. In Ethiopia, delayed presentation (DP) for HIV care among vulnerable groups such as tuberculosis (Tb) /HIV co-infected patients has not been assessed. We aimed to assess the prevalence of and factors associated with DP (CD4 < 200 cells/μl at first visit) among Tb/HIV co-infected patients in southwest Ethiopia.


METHODS
A retrospective observational cohort study collated Tb/HIV data from Jimma University Teaching Hospital for the period of September 2010 and August 2012. The data analysis used logistic regression model at P value of ≤ 0.05 in the final model.


RESULTS
The prevalence of DP among Tb/HIV co-infected patients was 59.9 %. Tb/HIV co-infected patients who had a house with at least two rooms were less likely (AOR, 0.5; 95 % CI: 0.3-1.0) to present late than those having only single room. Tobacco non-users of Tb/HIV co-infected participants were also 50 % less likely (AOR, 0.5; 95 % CI: 0.3-0.8) to present late for HIV care compared to tobacco users. The relative odds of DP among Tb/HIV co-infected patients with ambulatory (AOR, 1.8; 95 % CI, 1.0-3.1) and bedridden (AOR, 8.3; 95 % CI, 2.8-25.1) functional status was higher than with working status.


CONCLUSIONS
Three out of five Tb/HIV co-infected patients presented late for HIV care. Higher proportions of DP were observed in bedridden patients, tobacco smokers, and those who had a single room residence. These findings have intervention implications and call for effective management strategies for Tb/HIV co-infection including early HIV diagnosis and early linkage to HIV care services.
Department of Epidemiology, College of Health Sciences, Jimma University, Jimma, Ethiopia. hailushepi@gmail.com.|Discipline of Public Health, Faculty of Medicine, Nursing and Health Sciences, Flinders University, Adelaide, Australia. hailushepi@gmail.com.
Hailay
http://orcid.org/0000-0002-3531-4400
H
Gesesew
Department of Epidemiology, College of Health Sciences, Jimma University, Jimma, Ethiopia.|School of Statistics and Mathematics, Faculty of Science, Alberta University, Edmonton, Canada.
Birtukan
B
Tsehaineh
Department of Epidemiology, College of Health Sciences, Jimma University, Jimma, Ethiopia.
Desalegn
D
Massa
Department of population and Family Health, College of Health Sciences, Jimma University, Jimma, Ethiopia.
Amanuel
A
Tesfay
ART Clinic, Filtu Hospital, Somali, Ethiopia.
Hafte
H
Kahsay
Discipline of Public Health, Faculty of Medicine, Nursing and Health Sciences, Flinders University, Adelaide, Australia.
Lillian
L
Mwanri
D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D015331:Cohort Studies; D060085:Coinfection / Q000150:complications* / Q000453:epidemiology*; D005002:Ethiopia / Q000453:epidemiology; D005260:Female; D015658:HIV Infections / Q000150:complications* / Q000453:epidemiology*; D006785:Hospitals, University; D006801:Humans; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D015995:Prevalence; D012189:Retrospective Studies; D012959:Socioeconomic Factors; D014376:Tuberculosis / Q000150:complications* / Q000453:epidemiology*; D055815:Young Adult
Co-infection; Delayed presentation; Ethiopia; HIV; Late presentation; Prevalence; Retrospective cohort; Tuberculosis