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Abstract：
BACKGROUND: Late presentation with advanced HIV disease (LP-AHD) remains a significant challenge to Human Immunodeficiency Virus (HIV) care, contributing to increased morbidity, mortality, and healthcare costs. Despite global efforts to enhance early diagnosis, a considerable proportion of individuals with HIV infection are unaware of being infected and therefore present late for HIV care. For the first time in Ghana, this study assessed the prevalence of LP-AHD and associated factors among people diagnosed with HIV (PDWH).
METHODS: This bi-center retrospective cross-sectional study included 315 PDWH at the Aniniwah Medical Centre and Komfo Anokye Teaching Hospital, both in Kumasi, Ghana. A well-structured questionnaire was used to collect data on sociodemographic, clinical, lifestyle and psychosocial factors from the study participants. Statistical analyses were done in SPSS version 26.0 and GraphPad Prism version 8.0 at significant p-value of < 0.05 and 95% confidence interval. Predictors of LP-AHD were assessed using binary logistic regression models.
RESULTS: This study observed that, 90 out of the 315 study PDWH (28.6%) reported late with advanced HIV disease (AHD). Participants within the age group of 36-45 years (adjusted Odds Ratio [aOR]: 0.32, 95% CI: 0.14-0.69; p = 0.004) showed a significantly decreased likelihood of LP-AHD. However, participants who perceived cost of HIV care to be high (aOR: 7.04, 95% CI: 1.31-37.91; p = 0.023), who were diagnosed based on clinical suspicion (aOR: 13.86, 95 CI: 1.83-104.80; p = 0.011), and missed opportunities for early diagnosis by clinicians (aOR: 2.47, 95% CI: 1.30-4.74; p = 0.006) were significantly associated with increased likelihood of LP-AHD.
CONCLUSIONS: The prevalence of LP-AHD among PDWH in Ghana is high. Efforts to improve early initiation of HIV/AIDS care should focus on factors such as the high perceived costs of HIV care, diagnosis based on clinical suspicion, and missed opportunities for early diagnosis by physicians.
METHODS: This bi-center retrospective cross-sectional study included 315 PDWH at the Aniniwah Medical Centre and Komfo Anokye Teaching Hospital, both in Kumasi, Ghana. A well-structured questionnaire was used to collect data on sociodemographic, clinical, lifestyle and psychosocial factors from the study participants. Statistical analyses were done in SPSS version 26.0 and GraphPad Prism version 8.0 at significant p-value of < 0.05 and 95% confidence interval. Predictors of LP-AHD were assessed using binary logistic regression models.
RESULTS: This study observed that, 90 out of the 315 study PDWH (28.6%) reported late with advanced HIV disease (AHD). Participants within the age group of 36-45 years (adjusted Odds Ratio [aOR]: 0.32, 95% CI: 0.14-0.69; p = 0.004) showed a significantly decreased likelihood of LP-AHD. However, participants who perceived cost of HIV care to be high (aOR: 7.04, 95% CI: 1.31-37.91; p = 0.023), who were diagnosed based on clinical suspicion (aOR: 13.86, 95 CI: 1.83-104.80; p = 0.011), and missed opportunities for early diagnosis by clinicians (aOR: 2.47, 95% CI: 1.30-4.74; p = 0.006) were significantly associated with increased likelihood of LP-AHD.
CONCLUSIONS: The prevalence of LP-AHD among PDWH in Ghana is high. Efforts to improve early initiation of HIV/AIDS care should focus on factors such as the high perceived costs of HIV care, diagnosis based on clinical suspicion, and missed opportunities for early diagnosis by physicians.
摘要：
背景：晚期HIV疾病（LP-AHD）的晚期表现仍然是人类免疫缺陷病毒（HIV）护理的重大挑战，导致发病率增加，死亡率,和医疗费用。尽管全球努力加强早期诊断，相当大比例的HIV感染者没有意识到被感染,因此出现在HIV护理后期.第一次在加纳，这项研究评估了被诊断为HIV(PDWH)的人群中LP-AHD的患病率及相关因素.
方法：这项双中心回顾性横断面研究包括Aniniwah医学中心和KomfoAnokye教学医院的315个PDWH，都在库马西，加纳。使用结构良好的问卷来收集有关社会人口统计学的数据，临床,研究参与者的生活方式和社会心理因素。在SPSS版本26.0和GraphPadPrism版本8.0中以<0.05和95%置信区间的显著p值进行统计分析。使用二元逻辑回归模型评估LP-AHD的预测因子。
结果：这项研究观察到，315项研究中有90项PDWH（28.6％）报告晚期HIV疾病（AHD）。36-45岁年龄段的参与者（调整后的赔率比[aOR]：0.32，95％CI：0.14-0.69；p=0.004）显示出LP-AHD的可能性显着降低。然而,认为艾滋病毒护理费用高的参与者(OR：7.04，95%CI：1.31-37.91；p=0.023)，根据临床怀疑诊断（aOR：13.86，95CI：1.83-104.80；p=0.011），和错过临床医生早期诊断的机会(aOR:2.47,95%CI:1.30-4.74;p=0.006)与LP-AHD的可能性增加显著相关.
结论：加纳PDWH中LP-AHD的患病率很高。改善艾滋病毒/艾滋病护理的早期启动的努力应侧重于诸如艾滋病毒护理的高成本，基于临床怀疑的诊断，错过了医生早期诊断的机会。
方法：这项双中心回顾性横断面研究包括Aniniwah医学中心和KomfoAnokye教学医院的315个PDWH，都在库马西，加纳。使用结构良好的问卷来收集有关社会人口统计学的数据，临床,研究参与者的生活方式和社会心理因素。在SPSS版本26.0和GraphPadPrism版本8.0中以<0.05和95%置信区间的显著p值进行统计分析。使用二元逻辑回归模型评估LP-AHD的预测因子。
结果：这项研究观察到，315项研究中有90项PDWH（28.6％）报告晚期HIV疾病（AHD）。36-45岁年龄段的参与者（调整后的赔率比[aOR]：0.32，95％CI：0.14-0.69；p=0.004）显示出LP-AHD的可能性显着降低。然而,认为艾滋病毒护理费用高的参与者(OR：7.04，95%CI：1.31-37.91；p=0.023)，根据临床怀疑诊断（aOR：13.86，95CI：1.83-104.80；p=0.011），和错过临床医生早期诊断的机会(aOR:2.47,95%CI:1.30-4.74;p=0.006)与LP-AHD的可能性增加显著相关.
结论：加纳PDWH中LP-AHD的患病率很高。改善艾滋病毒/艾滋病护理的早期启动的努力应侧重于诸如艾滋病毒护理的高成本，基于临床怀疑的诊断，错过了医生早期诊断的机会。
