Risk factors for late HIV diagnosis in England, 2015-2023

Late HIV diagnosis increases the risk of premature mortality and onward transmission. We analyzed the risk factors for late diagnosis in England to inform future testing strategies.

We extracted data from the national HIV surveillance system on all new HIV diagnoses in England residents aged 15 years and older reported between 2015 and 2023 and classified as likely acquiring HIV via sexual transmission. Late diagnosis was defined as a CD4 count <350 cells/mm³ within 91 days of diagnosis and no evidence of recent infection. Using multivariable logistic regression, we estimated associations between late diagnosis and age, gender, ethnicity, deprivation, rurality, region of residence, birth in the United Kingdom, likely route of exposure and diagnosis year.

A total of 18 217 diagnoses were included, of which 7177 (39%) were late. Key time-invariant risk factors for late diagnosis included older age (adjusted odds ratio: 1.44 per 10 years, 95% confidence interval: 1.40-1.49) and, for individuals born outside the United Kingdom, Asian (aOR: 1.69, 95% CI: 1.44-1.98) and Black African (aOR: 1.43, 95% CI: 1.28-1.61) ethnicity. The predicted probability of late diagnosis in men likely exposed via sex with men increased from 21% in 2015 to 32% in 2023, although it was consistently lower than individuals likely exposed through sex between men and women.

Targeted and accessible HIV testing approaches, which extend beyond sexual health services, should be prioritized for older adults, individuals exposed via sex between men and women, and non-UK-born ethnic minority groups.