[Barriers to timely HIV diagnosis in the rapid testing era]

Late diagnosis (LD) of HIV infection, defined as a CD4+ cell count below 350 cells/uL or the presence of an AIDS-defining illness, remains a major public health problem due to its association with increased morbidity, mortality, and ongoing transmission. We aimed to identify factors associated with LD among individuals with a new HIV diagnosis.

We conducted an observational mixed-methods study including adults with a recent HIV diagnosis consecutively enrolled at a referral hospital in Buenos Aires between October 2023 and January 2025. Quantitative analyses evaluated factors associated with LD, while qualitative interviews explored barriers to HIV testing and healthcare access.

A total of 102 patients were included (median age 32 years; median CD4+ count 294 cells/uL). Late diagnosis was observed in 59.8% of cases. Seven patients died from AIDS-related causes, all in the LD group. Older age and heterosexual orientation were independently associated with LD. Notably, 36.1% of participants had at least one healthcare visit in the year prior to diagnosis, representing missed opportunities for testing. During follow-up, 92.2% achieved viral suppression at six months, with no new AIDS-defining events. Qualitative findings identified self-perceived good health, low awareness of HIV testing, and perceived exclusion from healthcare services as barriers to timely diagnosis.

More than half of patients were diagnosed late, with frequent missed opportunities for earlier detection. These findings support the need for expanded and targeted HIV testing strategies to reduce preventable morbidity and mortality.