Late HIV diagnosis and delay in CD4 count measurement among HIV-infected patients in Southern Thailand

Abstract

The objectives of this study were to evaluate timeliness of HIV testing and of getting CD4 count measured and their associated factors in Southern Thailand. Between July 2004 and February 2005, consenting HIV-positive patients from seven public hospitals in Songkhla province, Southern Thailand were interviewed. Outcomes were late HIV diagnosis (having HIV-related symptoms at the time of first positive test) and the time between HIV diagnosis and first CD4 count being measured. Of 402 study patients, 55% were late HIV-diagnosed. Factors independently associated with late HIV diagnosis were age above 30 years, male and being unemployed with respective odd ratios (95% CI) of 3.10 (1.90–5.07), 7.95 (4.52–13.99), and 2.14 (1.22–3.76). Only 34% and 47% received CD4 assessment within 6 and 12 months of HIV diagnosis, respectively. Median of first-known CD4 count was 73 (IQR 16–169) and 22 (IQR 9–85) cells/µl among asymptomatic and symptomatic HIV-diagnosed patients, respectively. Common predictors for shortened delay of CD4 count measured among symptomatic and asymptomatic HIV-diagnosed patients were: infection through sexual contact (HR=1.61; 95%CI 1.12–2.33) and receiving posttest counseling (HR 1.71; 95%CI 1.15–2.52). Among the asymptomatic, those aged >25–30 years had significantly shortened delay (HR=2.18; 95%CI 1.50–3.18) compared with the younger age group as did those aged >30 years (HR=1.94; 95%CI 1.32–2.85). Such age effect on the delay was absent in the symptomatic group. Attempts to diagnose HIV at an earlier stage and timely CD4 count measured are needed.

Acknowledgements

This research was funded by the office of the World Health Organization Representative to Thailand and Prince of Songkla University. The authors would like to thank all the respondents who gave their valuable time to answer very personal questions. We gratefully acknowledge Dr A F Geater who provided valuable comments on drafts of this paper and the hospital staff that enabled us to complete this study.