Abstract:

Background: HIV still causes high morbidity in the era of highly active antiretroviral therapy (HAART). Despite scaling up of HIV and treatment services to improve the outcome of people living with HIV/AIDS, there is still a high proportion of individuals who seek out medical attention in late stages of the disease. This phenomenon contributes to late initiation of ART and poor clinical outcome especially in sub Saharan Africa. The magnitude of this problem and risk factors is not known in Tanzania. This study was designed to describe the prevalence of late HIV diagnosis and its risk factors in western rural Tanzania.

Methods: This was a cross sectional based cohort study, involving newly diagnosed adult HIV patients sent in for care and treatment linkage. Data of interest including age, sex, WHO stage, stage of opportunistic infection on diagnosis, mode of diagnosis and CD4 were all recorded and analyzed using STATA version 11.2. Patients with on diagnosis CD4<200 cells/µl were considered having late HIV diagnosis. The proportion of patients with late HIV diagnosis was calculated and logistic regression modal was used to determine the degree of association of different variable at 95%CI.

Results: A total of 649 patients were included in this study with a median age of 45.5 (22-71) years whereby most of them 396 (61.02%) were females. Majority of our study participants, 468 (72.11%) were in WHO clinical stage 3&4. About 385 (59.32%) of the patients had late HIV diagnosis, of whom 303 (78.70) had WHO clinical stage 3&4 defining illnesses on diagnosis, and these were predominantly male patients (OR=1.4, p=0.035), who were most likely to be diagnosed through provider initiated testing and counseling (OR=03, p=0.001).

Conclusion: The magnitude of patients with late HIV diagnosis is significantly big in western rural part of Tanzania with attendant high prevalence of most stage 3&4 AIDS defining illnesses. Male participants seem to be predominantly affected as late presenters.