Format

Send to

Choose Destination
J Int AIDS Soc. 2015 Nov 18;18:20317. doi: 10.7448/IAS.18.1.20317. eCollection 2015.

Reasons for late presentation to HIV care in Switzerland.

Author information

1
Department of Infectious Diseases, Bern University Hospital, University of Bern, Bern, Switzerland.
2
Division of Infectious Diseases and Hospital Epidemiology, University Hospital Zurich, University of Zurich, Zurich, Switzerland.
3
Division of Infectious Diseases and Hospital Epidemiology, University Hospital Lausanne, Lausanne, Switzerland.
4
Division of Infectious Diseases and Hospital Epidemiology, University Hospital Geneva, Geneva, Switzerland.
5
Division of Infectious Diseases and Hospital Epidemiology, University Hospital Basel, University of Basel, Basel, Switzerland.
6
Cantonal Hospital, St. Gallen, Switzerland.
7
Regional Hospital, Lugano, Switzerland.
8
Cantonal Hospital Aargau, Aargau, Switzerland.
9
Cantonal Hospital Baselland, Bruderholz, University of Basel, Basel, Switzerland.
10
Department of Infectious Diseases, Bern University Hospital, University of Bern, Bern, Switzerland; hansjakob.furrer@insel.ch.
11
Institute of Social and Preventive Medicine, University of Bern, Switzerland; gilles.wandeler@ispm.unibe.ch.

Abstract

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.

KEYWORDS:

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

PMID:
26584954
PMCID:
PMC4653319
DOI:
10.7448/IAS.18.1.20317
[Indexed for MEDLINE]
Free PMC Article

Supplemental Content

Full text links

Icon for Wiley Icon for PubMed Central
Loading ...
Support Center