Kakaire A. Kirunda
8 July 2009
A new study conducted in western Uganda shows that 40 per cent of patients with HIV have their infection diagnosed when they are already ill because of HIV, or have developed Aids.
Publishing last month in the Journal of Acquired Immune Deficiency Syndrome, the study believes that this figure is likely to represent the lower bound for the number of patients diagnosed late.
These findings came after researchers at the Mbarara University Teaching Hospital in Uganda conducted a cross-sectional study lasting one year to identify the proportion of patients diagnosed late and the factors accompanying late presentation.
Up to 2311 individuals were included in the study which found men (50 per cent) as the more likely to be diagnosed late than women (36 per cent), as were non-pregnant women at 36 per cent compared to pregnant women at 15 per cent. "The median age of the patients was 33 years (range 16-81 years), and 64 per cent were female. More than one third (40 per cent) were categorised as late presenters, that is, World Health Organisation disease stage three or four," according to the findings. "Male gender, age 46-60 years (vs. younger), lower education level, being unemployed, living in a household with others, being unmarried, and lack of spousal HIV status disclosure were independently associated with late presentation, whereas being pregnant, having young children, and consuming alcohol in the prior year were associated with early presentation."
To this, the researchers concluded that targeted public health interventions to facilitate earlier entry into HIV care are needed, as well as additional study to determine whether late presentation is due to delays in testing versus delays in accessing care.
The study came at a time when access to free anti-retroviral therapy in sub-Saharan Africa has been steadily increasing, and the success of large-scale anti-retroviral therapy programmes depends on early initiation of HIV care.
But this is happening when little is known about the stage at which those infected with HIV present for treatment.
The 2004/05 National HIV/Aids Sero and Behaviour Survey by the Ministry of Health Surveillance Unit estimated that about 915,400 adults and children were living with HIV/Aids in 2005. Prevalence among adults aged 15-49yrs was estimated at 6.4 percent, 0.7 per cent among children less than five years, and 5.8 per cent among those aged 50-59.
The Ministry of Health estimated 132,500 new infections in 2005 alone, a figure that has not changed much to date. About 80,000 people dies annually as a result of Aids-related illnesses.
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