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Reasons for late presentation to HIV care in Switzerland.

Type of publication Peer-reviewed
Publikationsform Original article (peer-reviewed)
Author Hachfeld Anna, Ledergerber Bruno, Darling Katharine, Weber Rainer, Calmy Alexandra, Battegay Manuel, Sugimoto Kiyoshi, Di Benedetto Caroline, Fux Christoph A, Tarr Philip E, Kouyos Roger, Furrer Hansjakob, Wandeler Gilles,
Project Swiss HIV Cohort Study (SHCS)
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Original article (peer-reviewed)

Journal Journal of the International AIDS Society
Volume (Issue) 18
Page(s) 20317 - 20317
Title of proceedings Journal of the International AIDS Society
DOI 10.7448/ias.18.1.20317

Open Access

URL http://dx.doi.org/10.7448/IAS.18.1.20317
Type of Open Access Publisher (Gold Open Access)

Abstract

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). 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. 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. 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.
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