The epidemiology of delayed HIV diagnosis in Ibadan, Nigeria

Abstract

Background: Human immunodeficiency virus infection (HIV) is one of the major health burdens in Nigeria. Delayed HIV diagnosis remains a significant driver of HIV transmission. The causes of delayed diagnosis are unknown. This observational study investigated demographic risk factors for delayed HIV diagnosis, time from HIV infection to diagnosis and trends in the rate of positive HIV tests and delayed diagnosis in Ibadan, Nigeria. Methods: The Acquired immunodeficiency syndrome (AIDS) Prevention Initiative (APIN) database provided data on people living with HIV who enrolled for care between October 2013 and December 2018 at the Antiretroviral Therapy (ART) clinic in the University College Hospital, Ibadan, Nigeria. 3,458 patients aged 15 years or older, diagnosed with HIV for the first time, with available CD4 counts, were included in this study. Delayed HIV diagnosis was defined as the Cluster of Differentiation 4 (CD4) counts less than 350 cells/mm³ at the time of first diagnosis. An assessment of the association between the outcome variable (delayed HIV diagnosis) and the independent variables was conducted using logistic regression analysis to identify the risk factors for delayed HIV diagnosis, and the time interval between HIV infection and diagnosis was calculated based on the average CD4 decline rate. Results: A total of 3,458 patients were included. The prevalence of delayed HIV diagnosis was 1,993/3,458 (57.6%). Risk factors significantly associated with delayed HIV diagnosis in the multivariate analysis were older age, retiree, marriage separation, never married and widowed females. Risk factors significantly associated with an early HIV diagnosis were student and tertiary education. The mean time from infection to diagnosis was 6.3 years. A progressive decline in the rate of positive HIV tests and delayed HIV diagnosis were observed from 2014 to 2018. Conclusion: The rate of delayed HIV diagnosis was high but is declining with time. HIV testing implementation should focus on groups at risk of delayed diagnosis.