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. 2015 Nov 25;10(11):e0143320.
doi: 10.1371/journal.pone.0143320. eCollection 2015.

Advanced HIV Disease at Enrolment in HIV Care: Trends and Associated Factors over a Ten Year Period in Cambodia

Reaksmey Pe  1 , Bopha Chim  1 , Sopheak Thai  1 , Lutgarde Lynen  2 , Johan van Griensven  1   2
Affiliations

Advanced HIV Disease at Enrolment in HIV Care: Trends and Associated Factors over a Ten Year Period in Cambodia

Reaksmey Pe et al. PLoS One. .

Abstract

Background: Early HIV diagnosis and enrolment in care is needed to achieve early antiretroviral treatment (ART) initiation. Studies on HIV disease stage at enrolment in care from Asian countries are limited. We evaluated trends in and factors associated with late HIV disease presentation over a ten-year period in the largest ART center in Cambodia.

Methods: We conducted a retrospective analysis of program data including all ARV-naïve adults (> 18 years old) enrolling into HIV care from March 2003-December 2013 in a non-governmental hospital in Phnom Penh, Cambodia. We calculated the proportion presenting with advanced stage HIV disease (WHO clinical stage IV or CD4 cell count <100 cells/μL) and the probability of ART initiation by six months after enrolment. Factors associated with late presentation were determined using multivariate logistic regression.

Results: From 2003-2013, a total of 5642 HIV-infected patients enrolled in HIV care. The proportion of late presenters decreased from 67% in 2003 to 44% in 2009 and 41% in 2013; a temporary increase to 52% occurred in 2011 coinciding with logistical/budgetary constraints at the national program level. Median CD4 counts increased from 32 cells/μL (IQR 11-127) in 2003 to 239 cells/μL (IQR 63-291) in 2013. Older age and male sex were associated with late presentation across the ten-year period. The probability of ART initiation by six months after enrolment increased from 22.6% in 2003-2006 to 79.9% in 2011-2013.

Conclusion: Although a gradual improvement was observed over time, a large proportion of patients still enroll late, particularly older or male patients. Interventions to achieve early HIV testing and efficient linkage to care are warranted.

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Conflict of interest statement

Competing Interests: The authors have declared that no competing interests exist.

Figures

Fig 1
Fig 1. Evolution in the proportion of individuals enrolling with advanced HIV disease (CD4 cell count < 100 cells/μL or WHO clinical stage IV), Phnom Penh, Cambodia (2003–2013).
Fig 2
Fig 2. Evolution in the proportion of individuals enrolling with WHO clinical stage IV, Phnom Penh, Cambodia (2003–2013).
Fig 3
Fig 3. Evolution in the median CD4 count at enrolment into HIV care, Phnom Penh, Cambodia (2003–2013).
See this image and copyright information in PMC

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