S Afr Med J

BackgroundMany people living with HIV in South Africa (SA) are not aware of their seropositive status and are diagnosed late during the course of HIV infection. These individuals do not obtain the full benefit from available HIV care and treatment services.ObjectivesTo describe the prevalence of late presentation for HIV care among newly diagnosed HIV-positive individuals and evaluate sociodemographic variables associated with late presentation for HIV care in three high-burden districts of SA.MethodsWe used data abstracted from records of 8 138 newly diagnosed HIV-positive individuals in 35 clinics between 1 June 2014 and 31 March 2015 to determine the prevalence of late presentation among newly diagnosed HIV-positive individuals in selected high-prevalence health districts. Individuals were categorised as \u2018moderately late\u2019, \u2018very late\u2019 or \u2018extremely late\u2019 presenters based on specified criteria. Descriptive analysis was performed to measure the prevalence of late presentation, and multivariate regression analysis was conducted to identify variables independently associated with extremely late presentation.ResultsOverall, 79% of the newly diagnosed cases presented for HIV care late in the course of HIV infection (CD4+ count 64500 cells/ \u3bcL and/or AIDS-defining illness in World Health Organization (WHO) stage III/IV), 19% presented moderately late (CD4+ count 351 \u2013 500 cells/\u3bcL and WHO clinical stage I or II), 27% presented very late (CD4+ count 201 \u2013 350 cells/\u3bcL or WHO clinical stage III), and 33% presented extremely late (CD4+ count 64200 cells/\u3bcL and/or WHO clinical stage IV) for HIV care. Multivariate regression analysis indicated that males, non-pregnant women, individuals aged >30 years, and those accessing care in facilities located in townships and inner cities were more likely to present late for HIV care.ConclusionsThe majority of newly diagnosed HIV-positive individuals in the three high-burden districts (Gert Sibande, uThukela and City of Johannesburg) presented for HIV care late in the course of HIV infection. Interventions that encourage early presentation for HIV care should be prioritised in SA and should target males, non-pregnant women, individuals aged >30 years and those accessing care in facilities located in inner cities and urban townships.20172018-02-01T00:00:00ZCC999999/Intramural CDC HHS/United StatesU2G GH000391/GH/CGH CDC HHS/United States29262956PMC5792655892