DETERMINANTS OF LATE PRESENTATION TO HIV/AIDS CARE AMONG PEOPLE LIVING WITH HIV RECEIVING CARE IN HEALTH INSTITUTIONS OF SOUTHERN TIGRAY ZONE, NORTHERN ETHIOPIA: AN INSTITUTION BASED CASE CONROL STUDY.

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.