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Risk Factors for Delayed Entrance into Care after Diagnosis among Patients with Late-Stage HIV Disease in Southern Vietnam

Author

Listed:
  • Suresh Rangarajan
  • Hoang Nguyen Bao Tram
  • Catherine S Todd
  • Tran Thinh
  • Van Hung
  • Pham Thanh Hieu
  • Tran My Hanh
  • Khong Minh Chau
  • Nguyen Danh Lam
  • Pham Tri Hung
  • Gary West
  • Donn Colby

Abstract

Background: We surveyed HIV patients with late-stage disease in southern Vietnam to determine if barriers to access and service quality resulted in late HIV testing and delays from initial diagnosis to entry into HIV care. Methodology: 196 adult patients at public HIV clinics with CD4 counts less than 250 cells/mm3 completed a standardized questionnaire. We used multivariate analysis to determine risk factors for delayed entry into care, defined as >3 months time from diagnosis to registration. Results: Common reasons for delayed testing were feeling healthy (71%), fear of stigma and discrimination in the community (43%), time conflicts with work or school (31%), did not want to know if infected (30%), and fear of lack of confidentiality (27%). Forty-five percent of participants delayed entry into care with a median CD4 count of 65 cells/mm3. The most common reasons for delayed entry were feeling healthy (51%), fear of stigma and discrimination in the community (41%), time conflicts with work or school (33%), and fear of lack of confidentiality (26%). Independent predictors for delayed entry were feeling healthy (aOR 3.7, 95% CI 1.5–9.1), first positive HIV test at other site (aOR 2.9, CI 1.2–7.1), history of injection drug use (IDU) (aOR 2.9, 95% CI 1.1–7.9), work/school conflicts (aOR 4.3, 95% CI 1.7–10.8), prior registration at another clinic (aOR 77.4, 95% CI 8.6–697), detention or imprisonment (aOR 10.3, 95% CI 1.8–58.2), and perceived distance to clinic (aOR 3.7, 95% CI 1.0–13.7). Conclusion: Delayed entry into HIV care in Vietnam is common and poses a significant challenge to preventing AIDS and opportunistic infections, decreasing mortality, and reducing HIV transmission. Improved linkages between testing and care are needed, particularly for patients who feel healthy, as well as incarcerated and drug-using populations who may face structural and social barriers to accessing care.

Suggested Citation

  • Suresh Rangarajan & Hoang Nguyen Bao Tram & Catherine S Todd & Tran Thinh & Van Hung & Pham Thanh Hieu & Tran My Hanh & Khong Minh Chau & Nguyen Danh Lam & Pham Tri Hung & Gary West & Donn Colby, 2014. "Risk Factors for Delayed Entrance into Care after Diagnosis among Patients with Late-Stage HIV Disease in Southern Vietnam," PLOS ONE, Public Library of Science, vol. 9(10), pages 1-8, October.
  • Handle: RePEc:plo:pone00:0108939
    DOI: 10.1371/journal.pone.0108939
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    References listed on IDEAS

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    1. David J Finitsis & Jennifer A Pellowski & Blair T Johnson, 2014. "Text Message Intervention Designs to Promote Adherence to Antiretroviral Therapy (ART): A Meta-Analysis of Randomized Controlled Trials," PLOS ONE, Public Library of Science, vol. 9(2), pages 1-10, February.
    2. Paul K Drain & Elena Losina & Gary Parker & Janet Giddy & Douglas Ross & Jeffrey N Katz & Sharon M Coleman & Laura M Bogart & Kenneth A Freedberg & Rochelle P Walensky & Ingrid V Bassett, 2013. "Risk Factors for Late-Stage HIV Disease Presentation at Initial HIV Diagnosis in Durban, South Africa," PLOS ONE, Public Library of Science, vol. 8(1), pages 1-9, January.
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