The Characteristics Of Delayed Diagnosis For HIV And Missed Opportunities For Earlier Testing In Medical Institutions

ObjectiveTo understand the characteristics of delayed diagnosis among newly reported,heterosexually transmitted HIV-infected people and missed earlier testing opportunities in medical institutions and the predictors of delayed diagnosis and missed earlier detection opportunities in medical institutions.MethodsThe participants of the study were selected from newly diagnosis HIV cases from March 25 to December 31,2019 in six districts of Wenshan Prefecture and Lincang Prefecture in Yunnan Province,with the inclusion criterion of being?18 years old and transmission through heterosexual behavior.Through a face-to-face questionnaire,data on social demographic characteristics,personal sexual behavior and previous medical history were collected.Based on the first CD4+T lymphocyte counts,the time of infected and duration of infection at the time of diagnosis were estimated.The subjects who were detected in the medical institutions reported their medical history in the past five years,combined with the infection time of CD4 back-calculation method,If someone were diagnosed at the first visit to hospital after the time of HIV infection,they would be defined as non-missing the early detection opportunity.If someone had two or more medical experiences after the time of HIV infection,it means missing the early testing opportunity.The chi-square tests were used for the categorical variables of distributions.Univariate and multivariate logistic regression models were used to investigate the associated risk factors of delayed diagnosis and missed earlier detection opportunities in medical institutions in participants.Result:A total of 313 new HIV cases were enrolled in this study.The main results are as follows.1 Demographic characteristics and knowledge about AIDSThe median age of 313 participants was 45(36-54)years old,192(61.34%)were males,174(55.59%)were live in urban district and 268(85.62%)were peasants.Among the 313 participants,225(71.88%)had heard about AIDS before detection and 270(86.2%)participants self-assessed with no risk of HIV infection.Of the 313 respondents,64 denied risk sexual behaviors,165 reported high-risk sexual behaviors and 84 reported ordinary risk sexual behaviors.2 Estimated the duration of HIVThe infection years were calculated by the CD4 back calculation based model.The median of the time from HIV infection to diagnosis was 5.5 years(1.7-9.3 years).3 Delayed diagnosis and its predictorsAmong the 313 subjects,229(73.1%)were classified as delayed diagnosis by CD4 model.Multivariate analysis revealed that subjects with high-risk sexual behaviors(OR=3.323,95%CI:1.602-6.895),female(OR=2.458,95%CI:1.313-4.600)were more likely to diagnosis delay;compared with participants with personal monthly income more than 2000 yuan,the subjects with personal monthly income less than2000 yuan were more likely to have delayed diagnosis(OR=1.740,95%CI:1.041-2.909).4 Missed opportunities for earlier diagnosis and its influencing factors Among the 313 respondents,244 were detected in medical institutions.Among these participants,107(43.85%)had missed the earlier opportunities for diagnosis in medical institutions.Multivariate analysis revealed that female(OR=1.742,95%CI:1.023-2.967),those with permanent residence at the city level(OR=1.732,95%CI:1.036-2.895)were more likely to miss the early detection opportunities;unmarried,divorced or widowed(OR=0.492,95%CI:0.285-0.850)respondents were less likely to miss the early detection opportunities in medical institutions.Conclusion1 The AIDS knowledge known and awareness of personal risk among newly diagnosis,heterosexual sexually transmitted HIV-infected cases is poor,suggesting that health education lack of direction,especially people with high infection risk cannot be screened for targeted education.2 The time of delayed diagnosis among heterosexually transmitted HIV cases is long.Respondents who were female,individual with low income and high-risk sexual behaviors are more likely to have delayed diagnosis.Education and testing measures should strengthened,identify or mobilize person with high-risk sexual behaviour for early HIV screening.3 The proportion of missed earlier testing of HIV among heterosexual transmitted patients was high.Participants who were female,married or cohabiting and live in city level areas are more likely to miss the early detection opportunities The interval between the date of treatment date and diagnosis of the newly reported infected person in state hospital is longer.We should focus on improving the HIV testing strategies and capabilities of state medical institutions,and screen persons with high-risk for testing as early as possible.