Aniley Abebayehu Bitew, Ayele Tadesse Awoke, Zeleke Ejigu Gebeye, Kassa Assefa Andargie
Department of Public Health, College of Medicine and Health Sciences, Wollo University, P.O. Box: 1145, Dessiee, Ethiopia.
Department of Epidemiology and Biostatistics, Institute of Public Health, College of Medicine and Health Sciences, University of Gondar, P.O. Box:196, Gondar, Ethiopia.
BMC Public Health. 2016 Oct 12;16(1):1076. doi: 10.1186/s12889-016-3727-0.
Early HIV diagnosis and access to treatment is one of the most effective ways to prevent its further spread and to protect the health of those living with the virus. However, delay in diagnosis is the major risk factor for uptake of and response to antiretroviral therapy.
Institution-based unmatched case-control study design was used in the study. The study was conducted in Debre-Markos and Finote-Selam Hospitals, Northwest Ethiopia. Cases were people living with HIV who had CD4 count <350cells/mm or WHO clinical stage III and IV regardless of the CD4 count at first presentation and controls were those who had CD4 count ≥350cells/mm or WHO clinical stage I and II. If both criteria were available, the CD4 count was used in the study as World Health Organization recommended. A total of 392 respondents (196 cases and 196 controls) were recruited and selected systematically. The data were collected by trained nurses using chart review and interviewer administered structured questionnaire. Binary Logistic Regression Model was used to identify the factors associated with late HIV diagnosis.
About 95.9 % of study participants provided complete response. Having no understanding, compared to having understanding, about HIV/AIDS (AOR = 1.7, 95 %CI = 1.08-2.79) and ART (AOR = 2.1, 95 %CI: 1.25-3.72), being tested as a result of symptoms/ illness, compared to being tested for risk exposure (inverted AOR =2.5, 95 %CI: 1.64-4.76), and acquiring HIV through sexual contact, compared to acquiring it through other modes (AOR = 2.5, 95 %CI = 1.52-4.76) were positively and independently associated with late HIV diagnosis.
Unlike perceived HIV stigma, having no understanding about HIV and ART, being tested for presence of symptoms/illness, and acquiring HIV through sexual contact were independent and significant factors for late HIV diagnosis.
早期艾滋病毒诊断及获得治疗是预防其进一步传播和保护病毒感染者健康的最有效方法之一。然而，诊断延迟是接受抗逆转录病毒治疗及对其产生反应的主要风险因素。
本研究采用基于机构的非匹配病例对照研究设计。研究在埃塞俄比亚西北部的德布雷-马尔科斯医院和菲诺特-塞拉姆医院进行。病例为初次就诊时CD4细胞计数<350个/立方毫米或世界卫生组织临床分期为III期和IV期的艾滋病毒感染者，无论其CD4细胞计数如何，对照为CD4细胞计数≥350个/立方毫米或世界卫生组织临床分期为I期和II期的患者。如果两个标准都可用，则按照世界卫生组织的建议在研究中使用CD4细胞计数。共系统招募并选取了392名受访者（196例病例和196名对照）。数据由经过培训的护士通过查阅病历和使用访谈员管理的结构化问卷进行收集。采用二元逻辑回归模型来确定与艾滋病毒诊断延迟相关的因素。
约95.9%的研究参与者提供了完整的回答。与了解艾滋病毒/艾滋病知识相比，不了解（优势比=1.7，95%置信区间=1.08 - 2.79）以及与了解抗逆转录病毒治疗知识相比，不了解（优势比=2.1，95%置信区间：1.25 - 3.72），因出现症状/患病而接受检测，与因暴露于风险因素而接受检测相比（反向优势比=2.5，95%置信区间：），以及通过性接触感染艾滋病毒，与通过其他途径感染相比（优势比=2.5，95%置信区间=1.52 - 4.76）均与艾滋病毒诊断延迟呈正相关且具有独立性。
与感知到的艾滋病毒污名不同，不了解艾滋病毒和抗逆转录病毒治疗知识、因出现症状/患病而接受检测以及通过性接触感染艾滋病毒是艾滋病毒诊断延迟的独立且重要因素。
