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HIV Med. 2019 Feb;20(2):110-120. doi: 10.1111/hiv.12686. Epub 2018 Nov 14.

Late diagnosis, delayed presentation and late presentation among persons enrolled in a clinical HIV cohort in Ontario, Canada (1999-2013).

Author information

1
Ontario HIV Treatment Network, Toronto, Canada.
2
Baycrest Health Sciences, Toronto, Canada.
3
Division of Biostatistics, Dalla Lana School of Public Health, University of Toronto, Toronto, Canada.
4
Division of Clinical Public Health, Dalla Lana School of Public Health, University of Toronto, Toronto, Canada.
5
Women's College Research Institute, Women's College Hospital, Toronto, Ontario, Canada.
6
Canadian Positive People Network, Ottawa, Canada.
7
Ottawa Hospital Research Institute, Ottawa, Canada.
8
Bruyère Research Institute, Ottawa, Canada.
9
Department of Family Medicine, University of Ottawa, Ottawa, Canada.
10
Institute of Health Policy, Management and Evaluation, Dalla Lana School of Public Health, Toronto, Canada.
11
Department of Medicine, University of Toronto, Toronto, Canada.
12
AIDS Bureau, Ontario Ministry of Health and Long-Term Care, Toronto, Canada.
13
Sunnybrook Health Science Centre, Toronto, Canada.
14
Department of Molecular and Biomedical Sciences, Queen's University, Kingston, Canada.
15
Department of Public Health, Queen's University, Kingston, Canada.
16
Clinical Prevention Services, British Columbia Centre for Disease Control, Vancouver, Canada.
17
School of Population and Public Health, University of British Columbia, Vancouver, Canada.
18
Centre for Urban Health Solutions, Li Ka Shing Knowledge Institute, St Michael's Hospital, Toronto, Canada.
19
Department of Psychiatry, University of Toronto, Toronto, Canada.
20
Department of Family and Community Medicine, St Michael's Hospital, Toronto, Canada.
21
Department of Family and Community Medicine and Dalla Lana School of Public Health, University of Toronto, Toronto, Canada.

Abstract

OBJECTIVES:

Timely HIV diagnosis and presentation to medical care are important for treatment and prevention. Our objective was to measure late diagnosis, delayed presentation and late presentation among individuals in the Ontario HIV Treatment Network Cohort Study (OCS) who were newly diagnosed in Ontario.

METHODS:

The OCS is a multi-site clinical cohort study of people living with HIV in Ontario, Canada. We measured prevalence of late diagnosis [CD4 count < 350 cells/μL or an AIDS-defining condition (ADC) within 3 months of HIV diagnosis], delayed presentation (≥ 3 months from HIV diagnosis to presentation to care), and late presentation (CD4 count < 350 cells/μL or ADC within 3 months of presentation). We identified characteristics associated with these outcomes and explored their overlap.

RESULTS:

A total of 1819 OCS participants were newly diagnosed in Ontario from 1999 to 2013. Late diagnosis (53.0%) and presentation (54.0%) were common, and a quarter (23.1%) of participants were delayed presenters. In multivariable models, the participants of delayed presentation decreased over calendar time, but that of late diagnosis/presentation did not. Late diagnosis contributed to the majority (> 87%) of late presentation, and the prevalence of delayed presentation was similar among those diagnosed late versus early (13.4 versus 13.4%, respectively; P = 0.99). Characteristics associated with higher odds of late diagnosis/presentation in multivariable analyses included older age at diagnosis/presentation; African, Caribbean and Black race/ethnicity; Indigenous race/ethnicity; female sex; and being a male who did not report sex with men. There were lower odds of late diagnosis/presentation among participants who had ever injected drugs. In contrast, delayed presentation risk factors included younger age at diagnosis and having ever injected drugs.

CONCLUSIONS:

Late presentation is common in Ontario, as it is in other high-income countries. Our findings suggest that efforts to reduce late presentation should focus on facilitating earlier diagnosis for the populations identified in this analysis.

KEYWORDS:

HIV/AIDS; diagnosis; health care

PMID:
30430742
DOI:
10.1111/hiv.12686

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