Abstract:
Introduction: Late diagnosis and presentation to HIV/AIDS care lessens the benefits
of antiretroviral therapy and increase risk of HIV/AIDS transmission. A large number
of people present late for HIV care despite free accessible HIV care services. The
factors hindering patients’ early presentation to HIV care when HIV/AIDS care
services are accessible in lower health facilities is not known in Ethiopia.
Objectives: This study was conducted to identify determinants of late presentation to
HIV/AIDS care among HIV positives enrolled in HIV chronic care in Health institutions
in southern zone of Tigray, Northern Ethiopia.
Methods: An Institution based un-matched case-control study, supported with
phenomenology was conducted, among HIV positives enrolled in 6 HIV chronic care
clinics in Southern Tigray from March to April, 2014.Cases were late presenters_CD4
count <350 cells/μl or WHO stages 3 or 4 and Controls were with CD4 ≥ 350 cells/μl
and WHO stages 1 or 2 at first visit. Using 1:2, case: control ratio, 147 cases and 295
controls were included and selected systematically. Multiple logistic regression
models were used to identify determinants of late presentation.Qualitative data was
analyzed using thematic analysis complementing quantitative findings.
Result: A total of 147 cases and 266 controls participated in the study. In the
multiple logistic regression participants aged 25-29 (AOR = 3, CI: 1.2-8.1) and 35-
39(AOR = 4.1, CI: 1.4-12.5), having two (AOR = 6,CI: 1.3-28) and more( AOR =
5.2,CI: 1.1-24.8) lifetime sexual partners, with poor social support (AOR = 2.3,CI:
1.26-4.30), in the second wealth quintile(AOR = 3.3,CI:1.3-8.5), who perceived
stigma (AOR = 4.4,CI: 2.2-8.3) and losing income(AOR= 6.8 CI: 1.8-24.5) as barrier,
reported severe illness(AOR = 4.3,CI: 2.26-8) as reason for care seeking presented
late, while those who reported protecting family as reason for care(AOR = .19(.09 -
.37), presented in recent years and who disclosed HIV status to partner (AOR =
0.5,CI : 0.24 - 0.95) presented early compared to their counter parts . Use of nonmedical
care and male sex also deter timely care in the FGD.
Conclusion: In this study, HIV positives of older ages, low socio-economic status
and poor social support, denying disclosure and having perception of barriers in
recieving HIV care presented late.Efforts towards promoting early care seeking
should target these factors in the area and similar settings.
