Abstract
Introduction
In Cambodia, HIV treatment and care have become overburdened 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 in the 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 the proportion of HIV late presenters from 2003-2017 using the chi-square test for trends to detect significant changes. Bivariate analysis was used to determine the 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 was between 35 (SD= 8.6) and 37 years old (SD= 10.2) over time from 2003-2017. HIV late presenters slightly decreased from 66% (2003- 2007), 58% (2008- 2012), to 57% (2013- 2017) with a p-value < 0.001. Males, age group > 30 years old, single/divorced, occupation, residence, and WHO stage 3/4 were most significantly associated with HIV late presentation to care service (p-value < 0.05).
Conclusions
In spite of the national ART universal coverage policy with the Test and Treat approach, HIV late presentation remained relatively high. Being males, older age, single/divorced, small businessmen, and people from the Great lake region were identified as associated factors for late presentation. More effort needs to be invested in these populations to improve counseling, testing, and linkage system to early ART care to prevent severe OIs and death.