Factors associated with late presentation to HIV/AIDS care in South Wollo ZoneEthiopia: a case-control study

BACKGROUND: Access to free antiretroviral therapy in Sub-Saharan Africa has been steadily increasing. The success of large-scale antiretroviral therapy programs depends on early initiation of HIV/AIDs care. The purpose of the study was to examine factors associated with late presentation to HIV/AIDS care. METHODS: A case-control study was conducted in Dessie referral and Borumeda district hospitals from March 1 to 31, 2010, northern Ethiopia. A total of 320 study participants (160 cases and 160 controls) were included in the study. Cases were people living with HIV/AIDS (PLHA) who had a WHO clinical stage of III or IV or a CD4 lymphocyte count of less than 200/uL at the time of the first presentation to antiretroviral treatment (ART) clinics. Controls were PLHA who had WHO stage I or II or a CD4 lymphocyte count of 200/uL or more irrespective of clinical staging at the time of first presentation to the ART clinics of the hospitals cases and controls were interviewed by trained nurses using a pre-tested and structured questionnaire. In-depth interviews were conducted with ten health workers and eight PLHA. RESULTS: PLHA who live with their families OR = 3.29, 95%CI: 1.28-8.45), lived in a rented house OR = 2.52, 95%CI: 1.09-5.79, non-pregnant women OR = 9.3, 95% CI: 1.93-44.82, who perceived ART have many side effects OR = 6.23, 95%CI:1.63,23.82), who perceived HIV as stigmatizing disease OR = 3.1, 95% CI: 1.09-8.76, who tested with sickness/symptoms OR = 2.62, 95% CI: 1.26-5.44, who did not disclose their HIV status for their partner OR = 2.78, 95% CI: 1.02-7.56, frequent alcohol users OR = 3.55, 95% CI: 1.63-7.71 and who spent more than 120 months with partner at HIV diagnosisOR = 5.86, 95% CI: 1.35-25.41 were significantly associated with late presentation to HIV/AIDS care. The qualitative finding revealed low awareness, non-disclosure, perceived ART side effects and HIV stigma were the major barriers for late presentation to HIV/AIDS care. CONCLUSIONS: Efforts to increase early initiation of HIV/AIDS care should focus on addressing patient's concerns such as stigma, drug side effects and disclosure.