Factors Associated with Late Engagement to HIV Care in Western Kenya A Cross-Sectional Study

• Published in: Journal of the International Association of Providers of AIDS Care Vol. 15; no. 6; pp. 505 - 511
• Main Authors: Kwobah, Charles Meja, Braitstein, Paula, Koech, Julius K., Simiyu, Gilbert, Mwangi, Ann W., Wools-Kaloustian, Kara, Siika, Abraham M.
• Format: Journal Article
• Language: English
• Published: Los Angeles, CA SAGE Publications 01.11.2016
• Subjects: Adult; CD4 Lymphocyte Count; Cross-Sectional Studies; Female; HIV Infections - drug therapy; HIV Infections - epidemiology; HIV Infections - immunology; Humans; Kenya - epidemiology; Lentivirus; Male; Middle Aged; Retroviridae; Time-to-Treatment - statistics & numerical data; Young Adult; Kenya; Africa; advanced immune suppression; HIV; late presentation
• ISSN: 2325-9582; 2325-9574; 2325-9582
• DOI: 10.1177/2325957414567682

Background: Late presentation of patients contributes significantly to the high mortality reported in HIV -care and treatment programs in sub-Saharan Africa. Methods: A cross-sectional study was conducted to assess factors associated with late engagement to HIV care at the Academic Model Providing Access to Healthcare in western Kenya. Late engagement was defined as baseline CD4 ≤100 cells/mm3. Results: Of the 10 533 participants included in the analysis, 67% were female and mean age was 36.7 years. Overall, 23% of the participants presented late. Factors associated with late engagement included male gender (adjusted odds ratio [AOR]: 1.54, 95% confidence interval [CI]: 1.35-1.75), older age (AOR: 1.62, 95% CI: 1.02-2.56), and longer travel time to clinic (AOR: 1.18, 95% CI: 1.04-1.34). Conclusion: Nearly one-quarter of HIV-infected patients in our setting present with advanced immune suppression at initial encounter. Being male, older age, and living further away from clinic are associated with late engagement to care.