Risk factors for delayed entrance into care after diagnosis among patients with late-stage HIV disease in southern Vietnam.

Autor: Rangarajan S; FHI360 Vietnam, Ho Chi Minh City, Vietnam., Tram HN; FHI360 Vietnam, Ho Chi Minh City, Vietnam., Todd CS; Asia-Pacific Regional Office, FHI 360, Bangkok, Thailand., Thinh T; Ho Chi Minh City Provincial AIDS Committee, Ho Chi Minh City, Vietnam., Hung V; Ho Chi Minh City Provincial AIDS Committee, Ho Chi Minh City, Vietnam., Hieu PT; District 8 Preventive Medicine Center, Ho Chi Minh City, Vietnam., Hanh TM; An Giang Provincial AIDS Center, Long Xuyen, An Giang, Vietnam., Chau KM; Tinh Bien Hospital, An Giang, Vietnam., Lam ND; Can Tho Provincial AIDS Center, Can Tho, Vietnam., Hung PT; Thot Not Outpatient Clinic, Can Tho, Vietnam., West G; FHI360 Vietnam, Hanoi, Vietnam., Colby D; Center for Applied Research on Men and Health, Ho Chi Minh City, Vietnam; SEARCH, Thai Red Cross AIDS Research Center, Bangkok, Thailand.
Jazyk: angličtina
Zdroj: PloS one [PLoS One] 2014 Oct 16; Vol. 9 (10), pp. e108939. Date of Electronic Publication: 2014 Oct 16 (Print Publication: 2014).
DOI: 10.1371/journal.pone.0108939
Abstrakt: Background: We surveyed HIV patients with late-stage disease in southern Vietnam to determine if barriers to access and service quality resulted in late HIV testing and delays from initial diagnosis to entry into HIV care.
Methodology: 196 adult patients at public HIV clinics with CD4 counts less than 250 cells/mm3 completed a standardized questionnaire. We used multivariate analysis to determine risk factors for delayed entry into care, defined as >3 months time from diagnosis to registration.
Results: Common reasons for delayed testing were feeling healthy (71%), fear of stigma and discrimination in the community (43%), time conflicts with work or school (31%), did not want to know if infected (30%), and fear of lack of confidentiality (27%). Forty-five percent of participants delayed entry into care with a median CD4 count of 65 cells/mm3. The most common reasons for delayed entry were feeling healthy (51%), fear of stigma and discrimination in the community (41%), time conflicts with work or school (33%), and fear of lack of confidentiality (26%). Independent predictors for delayed entry were feeling healthy (aOR 3.7, 95% CI 1.5-9.1), first positive HIV test at other site (aOR 2.9, CI 1.2-7.1), history of injection drug use (IDU) (aOR 2.9, 95% CI 1.1-7.9), work/school conflicts (aOR 4.3, 95% CI 1.7-10.8), prior registration at another clinic (aOR 77.4, 95% CI 8.6-697), detention or imprisonment (aOR 10.3, 95% CI 1.8-58.2), and perceived distance to clinic (aOR 3.7, 95% CI 1.0-13.7).
Conclusion: Delayed entry into HIV care in Vietnam is common and poses a significant challenge to preventing AIDS and opportunistic infections, decreasing mortality, and reducing HIV transmission. Improved linkages between testing and care are needed, particularly for patients who feel healthy, as well as incarcerated and drug-using populations who may face structural and social barriers to accessing care.
Databáze: MEDLINE
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