Study On The Strategies And Factors Of Late HIV Diagnosis Among People Living With HIV/AIDS In The Southwest Area Of Mainland China

Objectives(1) To understand the status and epidemiologic characteristics of late HIVdiagnosis in Liuzhou city of Guangxi Zhuang Autonomous Region.(2) To identify the factors associated with late HIV diagnosis by univariate andmultivariate logistic regression analysis.(3) To identify the reasons for late HIV diagnosis and measures for detectingHIV infections earlier by qualitative research.(4) To explore the measures and strategies for detecting HIV infections earlierby combining quantitative and qualitative research results.MethodsA census method was used to select the study individuals. All individuals whowere newly diagnosed with HIV infection between1January2009and30June2010and lived in Liuzhou city were eligible. Late HIV diagnosis was defined as:an AIDS diagnosis when HIV diagnosed or developed AIDS within one year ofHIV diagnosis. The questionnaire included general information, high-riskexposure history, HIV testing history, medical history and HIV/AIDS-relatedknowledge. Moreover, a qualitative method was used to collect the reasons forlate HIV diagnosis and measures for detecting HIV infections earlier.Quantitative data were entered using EpiData3.02software and analyzed usingSPSS13.0software. Chi-square test were used for categorical variables. Multivariate logistic regression was used to identify factors independentlyassociated with late HIV diagnosis. Recording was transcribed into text firstly,and then a summary method was used to analyze the qualitative data.Results(1) Of the917study individuals,658(71.8%) had a late HIV diagnosis.(2)The epidemiologic characteristics of late HIV diagnosis individuals were asfollows: the most common HIV transmission route was heterosexualtransmission(86.9%); the blood sample source was dominated by “HIV testingfor persons sought medical treatment for illness”(57.6%);83.3%had a regularheterosexual partner, and54.6%did not know their regular heterosexualpartners’ HIV statuses;66.6%had casual heterosexual partners, and most ofthem(97.0%) did not know their casual heterosexual partners’ HIV statuses; only0.4%had male homosexual partners;9.2%had a history of needle sharing forinjecting drugs,0.8%had a history of plasma donation and1.7%had a history ofblood transfusion; majority (91.4%) did not have the idea of taking HIV testingbefore HIV diagnosis, the main reasons for not having the idea of taking HIVtesting were “Never thought I would be HIV-infected”,“I didn’t feel sick, so it wasimpossible to be infected with HIV”,“I have never heard of AIDS” and “I wasworry the discrimination from HIV-infection”;76.6%had one or more HIV-relatedsymptoms before HIV diagnosis, the most common symptoms were unexplainedweight loss, unexplained prolonged fever, recurrent respiratory tract infectionand recurrent cough/chest distress;85.0%sought medical treatment after thepresence of HIV-related symptoms, and most of them(77.4%) sought medicaltreatment at general hospitals, however, only nearly two thirds of the generalhospitals have offered HIV testing for these persons; majority knew few aboutHIV/AIDS-related knowledge before HIV diagnosis, and the total rate of questions about HIV/AIDS answered correctly was56.8%;70.3%knew someabout AIDS “Four Frees and One Care” policy before HIV diagnosis, but stillmore than half did not know the VCT clinic could offer free HIV testing.(3) The risk factors of late HIV diagnosis: lower annual household income,whose blood sample source was “HIV testing for persons sought medicaltreatment for illness”, thought themselves could not be infected with HIV fromtheir regular heterosexual partners, did not have the idea of taking HIV testingbefore HIV diagnosis, had unexplained weight loss or unexplained prolongedfever or angular cheilitis before HIV diagnosis, did not know whether needlesharing for injecting drugs occasionally could transmit HIV or thought needlesharing for injecting drugs occasionally could not transmit HIV. Among thesefactors, whose blood sample source was “HIV testing for persons soughtmedical treatment for illness”(OR=2.351, P=0.020), had unexplained weightloss(OR=2.577, P＜0.001) or unexplained prolonged fever(OR=2.111, P=0.004)or angular cheilitis(OR=2.860, P=0.042) before HIV diagnosis were importantrisk factors.(4) The protective factors of late HIV diagnosis: Those blood sample sourcewas “HIV testing for compulsory detoxification prisoners”(OR=0.203, P=0.013)were less likely to have late HIV diagnosis.(5) The reasons for late HIV diagnosis:①Knew few about AIDS, and neverthought I would be HIV-infected.②I didn’t feel sick, so it was impossible to beinfected with HIV.③I didn’t have high-risk behavior, so it was impossible to beinfected with HIV.④Did not know AIDS spreading so seriously.⑤Some peopletook some chances.⑥Some people were afraid to be testing HIV-infected, sothey did not take HIV testing always, such as having a HIV-infected spouse.⑦Knew some about AIDS, and most thought that AIDS was far away from theirown, so few took HIV testing on their own initiative.⑧Because of lower income, the majority sought medical treatment untill the presence of clinical symptoms orsick bad, and then got the HIV-positive result.⑨Worried the discrimination fromHIV-infection.⑩The current HIV testing scale was not enough, it was stilldominated by passive testing, the initiative testing was few.(6) The measures and strategies for detecting HIV infections earlier:①Although the AIDS health education work has been done for many years, itstill needs to improve the depth and extent of this work. It is essential tostrengthen the AIDS health education programs among the general population,especially in rural areas, to improve the risk perception of HIV infection.②Itneed to strengthen the anti-discrimination publicity, to reduce or eliminate thediscrimination against HIV/AIDS patients. Moreover, it is also important tostrengthen and ensure the confidentiality of HIV test results.③Greater effortsneed to be made to strengthen the AIDS health education programs amonghigh-risk groups, to let more high-risk groups to take HIV testing on their owninitiative. Moreover, it should take a variety of methods to attract high-risk groupsfor HIV testing. For example, taking manifold free testing project (including bloodsugar, urine sugar, blood type, free gynecologic examination) among FSW.④Expand the coverage of VCT and strengthen the publicity for VCT services, tolet more people understand the VCT services.⑤It should adopt a variety ofrapid testing methods, to shorten the time for test results, in order to facilitate thesubsequent follow-up and management for HIV/AIDS cases.⑥It is essential tostart PITC in hospitals. And, it is necessary to train the clinicians to improve theirrecognition of clinical presentations for underlying HIV infection and perform HIVtesting for these patients, especially the dermatology, respiratory, infectiousdiseases, internal medicine, fever clinics clinicians.⑦It need to promotespouse/sexual-partner notification for HIV-infected persons and to strengthenHIV testing for HIV-infected persons’ spouses/sexual-partners. For example, Guangxi Zhuang Autonomous Region government formulates the “GuangxiZhuang Autonomous Region regulations on HIV/AIDS patients’spouse/sexual-partners notification”, to require the HIV/AIDS patients to notifytheir spouse/sexual-partners about their HIV-positive results within one month, ifnot, they will be notified by the local CDC.⑧The local government should givepolicy support, and selected an area with serious HIV epidemic to make HIVcensus, such as Luzhai county. The investigation method could learn of the HIVepidemiologic survey for Butuo and Zhaojue counties of Liangshan Prefecture,Sichuan Province.⑨It should give full play to the existing HIV/AIDS detectedinstitutions, and perfect the cooperation mechanism between the HIV/AIDSdetected institutions and CDC, in order to strengthen the subsequent follow-upfor those detected HIV/AIDS cases and let them take CD4testing regularly andreceive antiretroviral treatment timely.ConclusionsThe status of late HIV diagnosis in Liuzhou city is rather serious. Lowknowledge awareness about HIV transmission route, not having the idea oftaking HIV testing before HIV diagnosis, whose blood sample source was “HIVtesting for persons sought medical treatment for illness”, having HIV-relatedsymptoms before HIV diagnosis are the independent risk factors of late HIVdiagnosis, so much attention should be given to the HIV/AIDS with this kind toprevent and intervene late HIV diagnosis. Those blood sample source was “HIVtesting for compulsory detoxification prisoners” were less likely to have late HIVdiagnosis, suggesting that offering HIV testing for compulsory detoxificationprisoners is beneficial for earlier HIV diagnosis. And, compulsory testing forother types of prisoners with HIV risk factors may improve the rate of early HIVdiagnosis. Meanwhile, it should take the measures and strategies for detecting HIV infections earlier in this study as the guidelines, to further start the detectionof HIV infections effectively and strengthen the subsequent follow-up for thosedetected HIV/AIDS cases, to let them take CD4testing regularly and receiveantiretroviral treatment timely.