Late disease stage at presentation to an HIV clinic in the era of free antiretroviral therapy in sub-Saharan Africa
Identifieur interne : 000F90 ( Pmc/Corpus ); précédent : 000F89; suivant : 000F91Late disease stage at presentation to an HIV clinic in the era of free antiretroviral therapy in sub-Saharan Africa
Auteurs : Isaac M. Kigozi ; Loren M. Dobkin ; Jeffrey N. Martin ; Elvin H. Geng ; Winnie Muyindike ; Nneka I. Emenyonu ; David R. Bangsberg ; Judith A. HahnSource :
- Journal of acquired immune deficiency syndromes (1999) [ 1525-4135 ] ; 2009.
Abstract
Access to free antiretroviral therapy (ART) in sub-Saharan Africa has been steadily increasing, and the success of large-scale ART programs depends on early initiation of HIV care. However, little is known about the stage at which those infected with HIV present for treatment in sub-Saharan Africa.
We conducted a cross-sectional analysis of initial visits to the Immune Suppression Syndrome Clinic of the Mbarara University Teaching Hospital, including patients who had their initial visit between February 2007 and February 2008 (N=2311).
Median age was 33 years (range 16–81). 64% were female. Over one-third (40%) were categorized as late presenters, that is World Health Organization disease stage 3 or 4. Male gender, age 46 to 60 (versus younger), lower education level, being unemployed, living in a household with others, being unmarried, and lack of spousal HIV status disclosure were independently associated with late presentation, while being pregnant, having young children, and consuming alcohol in the prior year were associated with early presentation.
Targeted public health interventions to facilitate earlier entry into HIV care are needed, as well as additional study to determine whether late presentation is due to delays in testing versus delays in accessing care.
Url:
DOI: 10.1097/QAI.0b013e3181ab6eab
PubMed: 19521248
PubMed Central: 2815238
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<record><TEI><teiHeader><fileDesc><titleStmt><title xml:lang="en">Late disease stage at presentation to an HIV clinic in the era of free antiretroviral therapy in sub-Saharan Africa</title><author><name sortKey="Kigozi, Isaac M" sort="Kigozi, Isaac M" uniqKey="Kigozi I" first="Isaac M." last="Kigozi">Isaac M. Kigozi</name><affiliation><nlm:aff id="A1">Uganda Research Initiative, San Francisco General Hospital, University of California, San Francisco</nlm:aff></affiliation></author><author><name sortKey="Dobkin, Loren M" sort="Dobkin, Loren M" uniqKey="Dobkin L" first="Loren M." last="Dobkin">Loren M. Dobkin</name><affiliation><nlm:aff id="A2">Division of Infectious Diseases, San Francisco General Hospital, University of California, San Francisco</nlm:aff></affiliation></author><author><name sortKey="Martin, Jeffrey N" sort="Martin, Jeffrey N" uniqKey="Martin J" first="Jeffrey N." last="Martin">Jeffrey N. Martin</name><affiliation><nlm:aff id="A3">Department of Epidemiology and Biostatistics, University of California, San Francisco</nlm:aff></affiliation></author><author><name sortKey="Geng, Elvin H" sort="Geng, Elvin H" uniqKey="Geng E" first="Elvin H." last="Geng">Elvin H. Geng</name><affiliation><nlm:aff id="A2">Division of Infectious Diseases, San Francisco General Hospital, University of California, San Francisco</nlm:aff></affiliation></author><author><name sortKey="Muyindike, Winnie" sort="Muyindike, Winnie" uniqKey="Muyindike W" first="Winnie" last="Muyindike">Winnie Muyindike</name><affiliation><nlm:aff id="A4">Faculty of Medicine, Mbarara University of Science and Technology</nlm:aff></affiliation></author><author><name sortKey="Emenyonu, Nneka I" sort="Emenyonu, Nneka I" uniqKey="Emenyonu N" first="Nneka I." last="Emenyonu">Nneka I. Emenyonu</name><affiliation><nlm:aff id="A5">Massachusetts General Hospital, Harvard School of Medicine, Harvard Initiative on Global Health</nlm:aff></affiliation></author><author><name sortKey="Bangsberg, David R" sort="Bangsberg, David R" uniqKey="Bangsberg D" first="David R." last="Bangsberg">David R. Bangsberg</name><affiliation><nlm:aff id="A5">Massachusetts General Hospital, Harvard School of Medicine, Harvard Initiative on Global Health</nlm:aff></affiliation></author><author><name sortKey="Hahn, Judith A" sort="Hahn, Judith A" uniqKey="Hahn J" first="Judith A." last="Hahn">Judith A. Hahn</name><affiliation><nlm:aff id="A2">Division of Infectious Diseases, San Francisco General Hospital, University of California, San Francisco</nlm:aff></affiliation></author></titleStmt><publicationStmt><idno type="wicri:source">PMC</idno><idno type="pmid">19521248</idno><idno type="pmc">2815238</idno><idno type="url">http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2815238</idno><idno type="RBID">PMC:2815238</idno><idno type="doi">10.1097/QAI.0b013e3181ab6eab</idno><date when="2009">2009</date><idno type="wicri:Area/Pmc/Corpus">000F90</idno><idno type="wicri:explorRef" wicri:stream="Pmc" wicri:step="Corpus" wicri:corpus="PMC">000F90</idno></publicationStmt><sourceDesc><biblStruct><analytic><title xml:lang="en" level="a" type="main">Late disease stage at presentation to an HIV clinic in the era of free antiretroviral therapy in sub-Saharan Africa</title><author><name sortKey="Kigozi, Isaac M" sort="Kigozi, Isaac M" uniqKey="Kigozi I" first="Isaac M." last="Kigozi">Isaac M. Kigozi</name><affiliation><nlm:aff id="A1">Uganda Research Initiative, San Francisco General Hospital, University of California, San Francisco</nlm:aff></affiliation></author><author><name sortKey="Dobkin, Loren M" sort="Dobkin, Loren M" uniqKey="Dobkin L" first="Loren M." last="Dobkin">Loren M. Dobkin</name><affiliation><nlm:aff id="A2">Division of Infectious Diseases, San Francisco General Hospital, University of California, San Francisco</nlm:aff></affiliation></author><author><name sortKey="Martin, Jeffrey N" sort="Martin, Jeffrey N" uniqKey="Martin J" first="Jeffrey N." last="Martin">Jeffrey N. Martin</name><affiliation><nlm:aff id="A3">Department of Epidemiology and Biostatistics, University of California, San Francisco</nlm:aff></affiliation></author><author><name sortKey="Geng, Elvin H" sort="Geng, Elvin H" uniqKey="Geng E" first="Elvin H." last="Geng">Elvin H. Geng</name><affiliation><nlm:aff id="A2">Division of Infectious Diseases, San Francisco General Hospital, University of California, San Francisco</nlm:aff></affiliation></author><author><name sortKey="Muyindike, Winnie" sort="Muyindike, Winnie" uniqKey="Muyindike W" first="Winnie" last="Muyindike">Winnie Muyindike</name><affiliation><nlm:aff id="A4">Faculty of Medicine, Mbarara University of Science and Technology</nlm:aff></affiliation></author><author><name sortKey="Emenyonu, Nneka I" sort="Emenyonu, Nneka I" uniqKey="Emenyonu N" first="Nneka I." last="Emenyonu">Nneka I. Emenyonu</name><affiliation><nlm:aff id="A5">Massachusetts General Hospital, Harvard School of Medicine, Harvard Initiative on Global Health</nlm:aff></affiliation></author><author><name sortKey="Bangsberg, David R" sort="Bangsberg, David R" uniqKey="Bangsberg D" first="David R." last="Bangsberg">David R. Bangsberg</name><affiliation><nlm:aff id="A5">Massachusetts General Hospital, Harvard School of Medicine, Harvard Initiative on Global Health</nlm:aff></affiliation></author><author><name sortKey="Hahn, Judith A" sort="Hahn, Judith A" uniqKey="Hahn J" first="Judith A." last="Hahn">Judith A. Hahn</name><affiliation><nlm:aff id="A2">Division of Infectious Diseases, San Francisco General Hospital, University of California, San Francisco</nlm:aff></affiliation></author></analytic><series><title level="j">Journal of acquired immune deficiency syndromes (1999)</title><idno type="ISSN">1525-4135</idno><imprint><date when="2009">2009</date></imprint></series></biblStruct></sourceDesc></fileDesc><profileDesc><textClass></textClass></profileDesc></teiHeader><front><div type="abstract" xml:lang="en"><sec id="S1"><title>Background</title><p id="P1">Access to free antiretroviral therapy (ART) in sub-Saharan Africa has been steadily increasing, and the success of large-scale ART programs depends on early initiation of HIV care. However, little is known about the stage at which those infected with HIV present for treatment in sub-Saharan Africa.</p></sec><sec sec-type="methods" id="S2"><title>Methods</title><p id="P2">We conducted a cross-sectional analysis of initial visits to the Immune Suppression Syndrome Clinic of the Mbarara University Teaching Hospital, including patients who had their initial visit between February 2007 and February 2008 (N=2311).</p></sec><sec id="S3"><title>Results</title><p id="P3">Median age was 33 years (range 16–81). 64% were female. Over one-third (40%) were categorized as late presenters, that is World Health Organization disease stage 3 or 4. Male gender, age 46 to 60 (versus younger), lower education level, being unemployed, living in a household with others, being unmarried, and lack of spousal HIV status disclosure were independently associated with late presentation, while being pregnant, having young children, and consuming alcohol in the prior year were associated with early presentation.</p></sec><sec id="S4"><title>Conclusions</title><p id="P4">Targeted public health interventions to facilitate earlier entry into HIV care are needed, as well as additional study to determine whether late presentation is due to delays in testing versus delays in accessing care.</p></sec></div></front></TEI><pmc article-type="research-article" xml:lang="EN"><pmc-comment>The publisher of this article does not allow downloading of the full text in XML form.</pmc-comment>
<pmc-dir>properties manuscript</pmc-dir>
<front><journal-meta><journal-id journal-id-type="nlm-journal-id">100892005</journal-id><journal-id journal-id-type="pubmed-jr-id">21821</journal-id><journal-id journal-id-type="nlm-ta">J Acquir Immune Defic Syndr</journal-id><journal-title>Journal of acquired immune deficiency syndromes (1999)</journal-title><issn pub-type="ppub">1525-4135</issn></journal-meta><article-meta><article-id pub-id-type="pmid">19521248</article-id><article-id pub-id-type="pmc">2815238</article-id><article-id pub-id-type="doi">10.1097/QAI.0b013e3181ab6eab</article-id><article-id pub-id-type="manuscript">NIHMS139783</article-id><article-categories><subj-group subj-group-type="heading"><subject>Article</subject></subj-group></article-categories><title-group><article-title>Late disease stage at presentation to an HIV clinic in the era of free antiretroviral therapy in sub-Saharan Africa</article-title></title-group><contrib-group><contrib contrib-type="author"><name><surname>Kigozi</surname><given-names>Isaac M.</given-names></name><degrees>MBChB Msc</degrees><xref ref-type="aff" rid="A1">1</xref></contrib><contrib contrib-type="author"><name><surname>Dobkin</surname><given-names>Loren M.</given-names></name><degrees>MPH</degrees><xref ref-type="aff" rid="A2">2</xref></contrib><contrib contrib-type="author"><name><surname>Martin</surname><given-names>Jeffrey N.</given-names></name><degrees>MD MPH</degrees><xref ref-type="aff" rid="A3">3</xref></contrib><contrib contrib-type="author"><name><surname>Geng</surname><given-names>Elvin H.</given-names></name><degrees>MD MPH</degrees><xref ref-type="aff" rid="A2">2</xref></contrib><contrib contrib-type="author"><name><surname>Muyindike</surname><given-names>Winnie</given-names></name><degrees>MBChB MMed</degrees><xref ref-type="aff" rid="A4">4</xref></contrib><contrib contrib-type="author"><name><surname>Emenyonu</surname><given-names>Nneka I.</given-names></name><degrees>MPH</degrees><xref ref-type="aff" rid="A5">5</xref></contrib><contrib contrib-type="author"><name><surname>Bangsberg</surname><given-names>David R.</given-names></name><degrees>MD MPH</degrees><xref ref-type="aff" rid="A5">5</xref></contrib><contrib contrib-type="author"><name><surname>Hahn</surname><given-names>Judith A.</given-names></name><degrees>PhD MA</degrees><xref ref-type="aff" rid="A2">2</xref></contrib></contrib-group><aff id="A1"><label>1</label>Uganda Research Initiative, San Francisco General Hospital, University of California, San Francisco</aff><aff id="A2"><label>2</label>Division of Infectious Diseases, San Francisco General Hospital, University of California, San Francisco</aff><aff id="A3"><label>3</label>Department of Epidemiology and Biostatistics, University of California, San Francisco</aff><aff id="A4"><label>4</label>Faculty of Medicine, Mbarara University of Science and Technology</aff><aff id="A5"><label>5</label>Massachusetts General Hospital, Harvard School of Medicine, Harvard Initiative on Global Health</aff><author-notes><corresp id="cor1">Corresponding author: Judith Hahn, PhD, UCSF Box 0811, San Francisco, CA 94143-0811, Phone 415.206.4435, Fax 415.648-8425, <email>judy.hahn@ucsf.edu</email></corresp></author-notes><pub-date pub-type="nihms-submitted"><day>16</day><month>9</month><year>2009</year></pub-date><pub-date pub-type="ppub"><month>10</month><year>2009</year></pub-date><pub-date pub-type="pmc-release"><day>1</day><month>10</month><year>2010</year></pub-date><volume>52</volume><issue>2</issue><fpage>280</fpage><abstract><sec id="S1"><title>Background</title><p id="P1">Access to free antiretroviral therapy (ART) in sub-Saharan Africa has been steadily increasing, and the success of large-scale ART programs depends on early initiation of HIV care. However, little is known about the stage at which those infected with HIV present for treatment in sub-Saharan Africa.</p></sec><sec sec-type="methods" id="S2"><title>Methods</title><p id="P2">We conducted a cross-sectional analysis of initial visits to the Immune Suppression Syndrome Clinic of the Mbarara University Teaching Hospital, including patients who had their initial visit between February 2007 and February 2008 (N=2311).</p></sec><sec id="S3"><title>Results</title><p id="P3">Median age was 33 years (range 16–81). 64% were female. Over one-third (40%) were categorized as late presenters, that is World Health Organization disease stage 3 or 4. Male gender, age 46 to 60 (versus younger), lower education level, being unemployed, living in a household with others, being unmarried, and lack of spousal HIV status disclosure were independently associated with late presentation, while being pregnant, having young children, and consuming alcohol in the prior year were associated with early presentation.</p></sec><sec id="S4"><title>Conclusions</title><p id="P4">Targeted public health interventions to facilitate earlier entry into HIV care are needed, as well as additional study to determine whether late presentation is due to delays in testing versus delays in accessing care.</p></sec></abstract><kwd-group><kwd>Antiretroviral therapy</kwd><kwd>access</kwd><kwd>sub-Saharan Africa</kwd><kwd>late presentation</kwd></kwd-group><contract-num rid="AI1">U01 AI069911-03
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