%0 Journal Article
%T Distribution of advanced HIV disease from three high HIV prevalence settings in Sub-Saharan Africa: a secondary analysis data from three population-based cross-sectional surveys in Eshowe (South Africa), Ndhiwa (Kenya) and Chiradzulu (Malawi)
%A Charlie Masiku
%A David Maman
%A Elisabeth Szumilin
%A Eric Goemaere
%A Gilles Van Cutsem
%A Helena Huerga
%A Jean-Francois Etard
%A Mary-Ann Davies
%A Menard L. Chihana
%A Stephen Wanjala
%A Tom Ellman
%J Global Health Action
%D 2019
%R https://doi.org/10.1080/16549716.2019.1679472
%X ABSTRACT Background: Despite substantial progress in antiretroviral therapy (ART) scale up, some people living with HIV (PLHIV) continue to present with advanced HIV disease, contributing to ongoing HIV-related morbidity and mortality. Objective: We aimed to quantify population-level estimates of advanced HIV from three high HIV prevalence settings in Sub-Saharan Africa. Methods: Three cross-sectional surveys were conducted in (Ndhiwa (Kenya): September每November 2012), (Chiradzulu (Malawi): February每May 2013) and (Eshowe (South Africa): July每October 2013). Eligible individuals 15每59 years old who consented were interviewed at home followed by rapid HIV test and CD4 count test if tested HIV-positive. Advanced HIV was defined as CD4 < 200 cells/米l. We used logistic regression to identify patient characteristics associated with advanced HIV. Results: Among 18,991 (39.2% male) individuals, 4113 (21.7%) tested HIV-positive; 385/3957 (9.7% (95% Confidence Interval [CI]: 8.8每10.7)) had advanced HIV, ranging from 7.8% (95%CI 6.4每9.5) Chiradzulu (Malawi) to 11.8% (95%CI 9.8每14.2) Ndhiwa (Kenya). The proportion of PLHIV with advanced disease was higher among men 15.3% (95% CI 13.2每17.5) than women 7.5% (95%CI 6.6每8.6) p < 0.001. Overall, 62.7% of all individuals with advanced HIV were aware of their HIV status and 40.3% were currently on ART. Overall, 65.6% of individuals not on ART had not previously been diagnosed with HIV, while only 29.6% of those on ART had been on ART for ≡6 months. Individuals with advanced HIV disease were more likely to be men (adjusted Odds Ratio [aOR]; 2.1 (95%CI 1.7每2.6), and more likely not to be on ART (aOR; 1.7 (95%CI 1.3每2.1). Conclusion: In our study, about 1 in 10 PLHIV had advanced HIV with nearly 40% of them unaware of their HIV status. However, a substantial proportion of patients with advanced HIV were established on ART. Our findings suggest the need for a dual focus on alternative testing strategies to identify PLHIV earlier as well as improving ART retention
%U https://www.tandfonline.com/doi/full/10.1080/16549716.2019.1679472