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dc.contributor.authorChihana, ML
dc.contributor.authorHuerga, H
dc.contributor.authorVan Cutsem, G
dc.contributor.authorEllman, T
dc.contributor.authorGoemaere, E
dc.contributor.authorWaniala, S
dc.contributor.authorMasiku, C
dc.contributor.authorSzumilin, E
dc.contributor.authorEtard, JF
dc.contributor.authorMaman, D
dc.contributor.authorDavies, MA
dc.date.accessioned2019-11-20T02:03:29Z
dc.date.available2019-11-20T02:03:29Z
dc.date.issued2019-11-04
dc.date.submitted2019-11-13
dc.identifier.urihttp://hdl.handle.net/10144/619528
dc.description.abstractBackground: Despite substantial progress in antiretroviral therapy (ART) scale up, some people living with HIV (PLHIV) continue to present with advanced HIV disease, contributing to ongoing HIV-related morbidity and mortality. Objective: We aimed to quantify population-level estimates of advanced HIV from three high HIV prevalence settings in Sub-Saharan Africa. Methods: Three cross-sectional surveys were conducted in (Ndhiwa (Kenya): September–November 2012), (Chiradzulu (Malawi): February–May 2013) and (Eshowe (South Africa): July–October 2013). Eligible individuals 15–59 years old who consented were interviewed at home followed by rapid HIV test and CD4 count test if tested HIV-positive. Advanced HIV was defined as CD4 < 200 cells/µl. We used logistic regression to identify patient characteristics associated with advanced HIV. Results: Among 18,991 (39.2% male) individuals, 4113 (21.7%) tested HIV-positive; 385/3957 (9.7% (95% Confidence Interval [CI]: 8.8–10.7)) had advanced HIV, ranging from 7.8% (95%CI 6.4–9.5) Chiradzulu (Malawi) to 11.8% (95%CI 9.8–14.2) Ndhiwa (Kenya). The proportion of PLHIV with advanced disease was higher among men 15.3% (95% CI 13.2–17.5) than women 7.5% (95%CI 6.6–8.6) p < 0.001. Overall, 62.7% of all individuals with advanced HIV were aware of their HIV status and 40.3% were currently on ART. Overall, 65.6% of individuals not on ART had not previously been diagnosed with HIV, while only 29.6% of those on ART had been on ART for ≥6 months. Individuals with advanced HIV disease were more likely to be men (adjusted Odds Ratio [aOR]; 2.1 (95%CI 1.7–2.6), and more likely not to be on ART (aOR; 1.7 (95%CI 1.3–2.1). Conclusion: In our study, about 1 in 10 PLHIV had advanced HIV with nearly 40% of them unaware of their HIV status. However, a substantial proportion of patients with advanced HIV were established on ART. Our findings suggest the need for a dual focus on alternative testing strategies to identify PLHIV earlier as well as improving ART retention.en_US
dc.language.isoenen_US
dc.publisherTaylor & Francisen_US
dc.rightsWith thanks to Taylor & Francis.en_US
dc.titleDistribution of advanced HIV disease from three high HIV prevalence settings in Sub-Saharan Africa: a secondary analysis data from three population-based cross-sectional surveys in Eshowe (South Africa), Ndhiwa (Kenya) and Chiradzulu (Malawi)en_US
dc.identifier.journalGlobal Health Actionen_US
refterms.dateFOA2019-11-20T02:03:29Z


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