Correlates of late HIV diagnosis: implications for testing policy

Area of Science:

• Public Health
• Epidemiology
• Infectious Diseases

Background:

• Delayed diagnosis of Human Immunodeficiency Virus (HIV) infection contributes to disease progression and onward transmission.
• Understanding factors associated with late HIV testing is crucial for developing effective public health interventions.
• Previous studies have identified various demographic and behavioral correlates of late HIV diagnosis.

Purpose of the Study:

• To identify correlates of late HIV diagnosis in a representative sample of HIV-infected individuals in France.
• To inform the development of targeted strategies to reduce delays in seeking HIV diagnosis.

Main Methods:

• Cross-sectional study of 1077 patients diagnosed with HIV between 1996 and enrolled in the ANRS-EN12-VESPA cohort.
• Late testers were defined as individuals with clinical AIDS events or CD4 cell count <200/mm(3) at diagnosis.
• Statistical analysis to identify factors associated with late diagnosis among different population subgroups.

Main Results:

• 33.1% of patients were classified as late testers, with 42.6% diagnosed at an AIDS event.
• Late diagnosis increased with age and was more prevalent in heterosexual men and migrants.
• Among non-migrant heterosexuals, late diagnosis was associated with stable relationships and children; among migrants, it was linked to lack of partnership and early arrival in France.

Conclusions:

• Low-risk behaviors for HIV infection were paradoxically associated with late testing.
• Public communication strategies should target stable couples (homosexual and heterosexual) with stable employment.
• Improved HIV testing with informed consent for migrants shortly after arrival, especially those not in a couple, is recommended.