Reasons for late presentation to HIV care in Switzerland.

Hachfeld, Anna; Ledergerber, Bruno; Darling, Katharine; Weber, Rainer; Calmy, Alexandra; Battegay, Manuel; Sugimoto, Kiyoshi; Di Benedetto, Caroline; Fux, Christoph A; Tarr, Philip E; Kouyos, Roger; Furrer, Hansjakob; Wandeler, Gilles (2015). Reasons for late presentation to HIV care in Switzerland. Journal of the International AIDS Society, 18(1), p. 20317. BioMed Central 10.7448/IAS.18.1.20317

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INTRODUCTION Late presentation to HIV care leads to increased morbidity and mortality. We explored risk factors and reasons for late HIV testing and presentation to care in the nationally representative Swiss HIV Cohort Study (SHCS). METHODS Adult patients enrolled in the SHCS between July 2009 and June 2012 were included. An initial CD4 count <350 cells/µl or an AIDS-defining illness defined late presentation. Demographic and behavioural characteristics of late presenters (LPs) were compared with those of non-late presenters (NLPs). Information on self-reported, individual barriers to HIV testing and care were obtained during face-to-face interviews. RESULTS Of 1366 patients included, 680 (49.8%) were LPs. Seventy-two percent of eligible patients took part in the survey. LPs were more likely to be female (p<0.001) or from sub-Saharan Africa (p<0.001) and less likely to be highly educated (p=0.002) or men who have sex with men (p<0.001). LPs were more likely to have their first HIV test following a doctor's suggestion (p=0.01), and NLPs in the context of a regular check-up (p=0.02) or after a specific risk situation (p<0.001). The main reasons for late HIV testing were "did not feel at risk" (72%), "did not feel ill" (65%) and "did not know the symptoms of HIV" (51%). Seventy-one percent of the participants were symptomatic during the year preceding HIV diagnosis and the majority consulted a physician for these symptoms. CONCLUSIONS In Switzerland, late presentation to care is driven by late HIV testing due to low risk perception and lack of awareness about HIV. Tailored HIV testing strategies and enhanced provider-initiated testing are urgently needed.

Item Type:

Journal Article (Original Article)

Division/Institute:

04 Faculty of Medicine > Pre-clinic Human Medicine > Institute of Social and Preventive Medicine
04 Faculty of Medicine > Department of Haematology, Oncology, Infectious Diseases, Laboratory Medicine and Hospital Pharmacy (DOLS) > Clinic of Infectiology

UniBE Contributor:

Hachfeld, Anna; Furrer, Hansjakob and Wandeler, Gilles

Subjects:

300 Social sciences, sociology & anthropology > 360 Social problems & social services
600 Technology > 610 Medicine & health

ISSN:

1758-2652

Publisher:

BioMed Central

Language:

English

Submitter:

Annelies Luginbühl

Date Deposited:

29 Dec 2015 17:04

Last Modified:

09 Feb 2016 10:20

Publisher DOI:

10.7448/IAS.18.1.20317

PubMed ID:

26584954

Additional Information:

Furrer and Wandeler contributed equally to this work.

Uncontrolled Keywords:

HIV infection; HIV testing; Switzerland; late presentation; self-reported reasons; success to care

BORIS DOI:

10.7892/boris.73297

URI:

https://boris.unibe.ch/id/eprint/73297

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