Introduction
Late presentation to HIV
care leads to increased morbidity and mortality. We explored risk factors and
reasons for late HIV testing and presentation to care in the nationally
representative Swiss HIV Cohort Study (SHCS).
Methods
Adult patients enrolled
in the SHCS between July 2009 and June 2012 were included. An initial CD4 count
<350 cells/µl or an AIDS-defining illness defined late presentation.
Demographic and behavioural characteristics of late presenters (LPs) were
compared with those of non-late presenters (NLPs). Information on
self-reported, individual barriers to HIV testing and care were obtained during
face-to-face interviews.
Results
Of 1366 patients
included, 680 (49.8%) were LPs. Seventy-two percent of eligible patients took
part in the survey. LPs were more likely to be female (p<0.001) or from sub-Saharan
Africa (p<0.001) and less likely to be
highly educated (p=0.002) or men who have sex with
men (p<0.001). LPs were more likely
to have their first HIV test following a doctor's suggestion (p=0.01), and NLPs in the context of
a regular check-up (p=0.02) or after
a specific risk situation (p<0.001). The
main reasons for late HIV testing were “did not feel at risk” (72%), “did not
feel ill” (65%) and “did not know the symptoms of HIV” (51%). Seventy-one
percent of the participants were symptomatic during the year preceding HIV
diagnosis and the majority consulted a physician for these symptoms.
Conclusions
In Switzerland, late
presentation to care is driven by late HIV testing due to low risk perception
and lack of awareness about HIV. Tailored HIV testing strategies and enhanced
provider-initiated testing are urgently needed.
Table 1
Demographic characteristics of late and non-late presenters
| Late presenters | Non-late presenters | ||
|---|---|---|---|
| N=680 (49.8%) | N=686 (50.2%) | p | |
| Demographic group (%) | <0.001 | ||
| MSM | 278 (40.9) | 421 (61.4) | |
| Non-MSM male | 198 (29.1) | 128 (18.6) | |
| Female | 204 (30.0) | 137 (20.0) | |
| Median age in years (IQR) | 40.6 (32.7–48.4) | 38.2 (31.0–45.4) | <0.001 |
| Median first CD4 count in cells/µl (IQR) | 195 (88–286) | 511 (417–663) | <0.001 |
| Region of origin (%) | <0.001 | ||
| South + Northwest Europe | 435 (64.0%) | 515 (75.3%) | |
| Sub-Saharan Africa | 126 (18.6%) | 69 (10.1%) | |
| South + East Asia | 51 (7.5%) | 17 (2.5%) | |
| Other | 67 (9.9%) | 83 (12.1%) | |
| High-level education (%) | 242 (35.6%) | 297 (43.4%) | 0.002 |
Table 2
Behavioural and clinical determinants of late presentation to care according to questionnaire data
| Late presenters | Non-late presenters | Total | ||
|---|---|---|---|---|
| (N=501) | (N=265) | (N=766) | p | |
| First positive test during hospitalization (%) | 104 (21.8) | 22 (8.8) | 126 (17.3) | <0.001 |
| Place of infection (%) | <0.001 | |||
| Switzerland | 193 (40.6) | 138 (55.4) | 331 (45.7) | |
| Abroad | 164 (34.5) | 76 (30.5) | 240 (33.1) | |
| Unknown | 119 (25.0) | 35 (14.1) | 154 (21.2) | |
| Remembers specific risk situation (%) | 160 (33.9) | 126 (50.6) | 286 (39.7) | <0.001 |
| Stable relationship (%)a | 288 (60.4) | 133 (52.8) | 415 (57.8) | 0.05 |
| Occasional sex partners (%)a | 242 (51.3) | 154 (61.9) | 396 (54.9) | 0.01 |
| Inconsistent condom use (%)a | 331 (79.4) | 173 (75.6) | 504 (78.0) | 0.26 |
| Symptomsb | ||||
| At least one symptom | 366 (73.3) | 177 (66.8) | 544 (71.0) | 0.06 |
| Fatigue | 175 (34.9) | 71 (26.8) | 246 (32.1) | 0.02 |
| Fever | 123 (24.6) | 73 (27.6) | 196 (25.6) | 0.37 |
| Weight loss | 142 (28.3) | 26 (9.8) | 168 (21.9) | <0.001 |
| Respiratory infection | 102 (20.4) | 46 (17.4) | 148 (19.3) | 0.32 |
| Skin lesions | 91 (18.2) | 28 (10.6) | 119 (15.5) | 0.01 |
| Diarrhoea | 85 (17.0) | 34 (12.8) | 119 (15.5) | 0.13 |
| Lymphadenopathy | 73 (14.6) | 45 (17.0) | 118 (15.4) | 0.38 |
| Oral lesions | 63 (12.6) | 19 (7.2) | 82 (10.7) | 0.02 |
| Muscle pain | 45 (9.0) | 24 (9.1) | 69 (9.0) | 0.97 |
| At least one of the following symptoms: fatigue, weight loss, oral or skin lesions | 254 (50.7) | 102 (38.5) | 356 (46.5) | 0.001 |
| Had a GP at time of diagnosis | 315 (66.2) | 173 (68.9) | 488 (67.1) | 0.45 |
| Consultation for symptoms | 234 (74.8) | 108 (73.0) | 342 (74.2) | 0.68 |
GP: general practitioner.
aDuring the six months before diagnosis;
Full article at:
By:
1Department of Infectious Diseases, Bern
University Hospital, University of Bern, Bern, Switzerland
2Division of Infectious Diseases and
Hospital Epidemiology, University Hospital Zurich, University of Zurich,
Zurich, Switzerland
3Division of Infectious Diseases and
Hospital Epidemiology, University Hospital Lausanne, Lausanne, Switzerland
4Division of Infectious Diseases and
Hospital Epidemiology, University Hospital Geneva, Geneva, Switzerland
5Division of Infectious Diseases and Hospital
Epidemiology, University Hospital Basel, University of Basel, Basel,
Switzerland
6Cantonal Hospital, St. Gallen, Switzerland
7Regional Hospital, Lugano, Switzerland
8Cantonal Hospital Aargau, Aargau,
Switzerland
9Cantonal Hospital Baselland, Bruderholz,
University of Basel, Basel, Switzerland
10Institute of Social and Preventive
Medicine, University of Bern, Switzerland
§Corresponding authors: Hansjakob Furrer, Department of Infectious
Diseases, University Hospital Bern, University of Bern, CH-3010 Bern,
Switzerland. Tel: +41 78 7758533. (Email: hc.lesni@rerruf.bokajsnah); Gilles
Wandeler, Department of Infectious Diseases, University Hospital Bern,
University of Bern, CH-3010 Bern, Switzerland. Tel: +41 78 7758533. (Email: hc.ebinu.mpsi@relednaw.sellig)
*These authors contributed equally to this work.
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