Vol. 2 No. 6 (2021): The trends of HIV late presenters in Sihanouk Hospital Center of HOPE and association between socio-demographic characteristics and late presentation to care service in Cambodia, 2003 - 2017
The trends of HIV late presenters in Sihanouk Hospital Center of HOPE and association between socio-demographic characteristics and late presentation to care service in Cambodia, 2003 - 2017

Pichsovannary Srey1*, Sodara Chan2, Kimcheng Choun1, Heng Sopheab2

1. Sihanouk Hospital Center of HOPE (SHCH), Cambodia

2. School of Public Health at National Institute of Public Health, Cambodia

* Corresponding author: Pichsovannary Srey, Email pichsovannarysrey@sihosp.org

ABSTRACT

 Introduction

In Cambodia, HIV treatment and care have become over burden on the current public health system. Despite the ART availability, patients continued to die and hospitalize, mostly because of their HIV advanced stages or late presentation to appropriate care services. We aimed to describe the trends of late presentation at care service of patients over time from 2003 to 2017 in Sihanouk Hospital Center of HOPE (SHCH), and to determine the association of socio-demographic characteristics with this late presentation.

Methods

We used data from SHCH electronic database by selecting all new HIV patients from March 2003 to December 2017 who were ART naïve with age ≥ 18 years old. In total, 5369 records were retrieved for analysis in Stata version 13. We calculated proportion of HIV late presenter from 2003-2017 using chi-square test for trends to detect significant changes. Bivariate analysis was used to determine association between socio-demographic factors and HIV late presenters, defined as CD4 count < 200 cell/ mm3.    

 Results

Of 5369 patients, the mean age at enrollment were between 35 (SD= 8.6) and 37 years old (SD= 10.2) over time from 2003-2017. HIV late presenters were slightly decreased from 66% (2003- 2007), 58% (2008- 2012), to 57% (2013- 2017) with p value < 0.001. Males, age group > 30 years old, single/divorce, occupation, residence, and WHO stage 3/4 were most significantly associated with HIV late presentation to care service (p value < 0.05).

Conclusion

In spite of the national ART universal coverage policy with Test and Treat approach, HIV late presentation remained relatively high. Being males, older age, single/divorced, small businessmen, and people from Great lake region were identified as associated factors for late presentation. More effort needs to be invested for these populations to improve counseling, testing and linkage system to early ART care to prevent severe OIs and death