Factors associated with Advanced Human Immunodeficiency Virus Disease among Patients Presenting to Care for the First Time at Health Facilities in Murewa District, Zimbabwe, 2021

  • Sexually Transmitted Diseases
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Advanced HIV disease (AHD) is a CD4 count below 200 cells/mm3 or WHO clinical stage 3 or 4 or HIV in any child under 5 years. Despite widespread awareness and expanded access to antiretroviral treatment (ART), 34.6% of people living with HIV in Murewa district presented to care with AHD in 2020. AHD can result in late ART initiation, inferior treatment outcomes and failure to end AIDS. We determined factors associated with AHD among patients presenting to care for the first time at health facilities in Murewa District.

We conducted a 1:1 unmatched case-control study. A case was a patient ≥18 years who tested HIV positive with WHO clinical stage 3 or 4 on first presentation to care at Murewa district health facilities in 2020. We selected hospital-based controls. We collected data on socio-demographics and factors associated with AHD from cases and controls guided by the health belief model. Backward logistic regression was done to identify independent factors for AHD.

We recruited 80 case-control pairs, 47 (58.7%) of the cases were males. Males 34 (42.5%) were less than females 46 (57.5%) in the control group. Independent risk factors associated with AHD at first presentation were fear of knowing one’s HIV status (aOR=1.59;95%CI:1.10-3.84) and reluctance to access healthcare due to waiting time of more than two hours at health facilities (aOR=4.90;95%CI:1.54-8.22) and unavailability of HIV diagnostic services (aOR=5.19;95%CI:1.89-9.46). A high-risk perception (aOR=0.35;95%CI:0.11-0.83) and staying with family (aOR=0.21;95%CI:0.09-0.71) were independently protective.

National AIDS Council through the Ministry of Health committed to procuring CD4 count reagents and servicing of laboratory machines to improve availability of services to HIV clients. Health education on knowing one’s HIV status early was given to the community during meetings. We recommended improving the health delivery system and scaling up community-based HIV testing services.

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