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. 2025 Apr 19;17(4):e82569.
doi: 10.7759/cureus.82569. eCollection 2025 Apr.

Proportion of Late Presenters to HIV Care and Barriers to Early Presentation: A Mixed-Methods Study at a Tertiary Care Hospital in Uttarakhand, India

Athulya V Ajith  1 , Meenakshi Khapre  2 , Smita Sinha  2 , Mukesh Bairwa  3 , Teja Srk  2
Affiliations

Proportion of Late Presenters to HIV Care and Barriers to Early Presentation: A Mixed-Methods Study at a Tertiary Care Hospital in Uttarakhand, India

Athulya V Ajith et al. Cureus. .

Abstract

Introduction: Late presentation to HIV care and delay of people living with HIV (PLHIV) linkage to ART continue to be a challenge in many countries of the world, including India. It has an adverse impact on the health of the patient and the outcome of antiretroviral therapy (ART) programs. In this study, we assessed the proportion of late presenters (LPs), factors associated with late presentation among PLHIV, and barriers to early presentation for HIV care among LPs in a tertiary center in India.

Methodology: A sequential mixed-method study in which the quantitative part was conducted among 156 PLHIV receiving treatment at the ART center of All India Institute of Medical Sciences, Rishikesh, India. It was followed by a qualitative study with in-depth interviews of LPs. Continuous variables such as age and CD4 count were presented as median and interquartile range (IQR) and analyzed using the Mann-Whitney U test. Categorical variables such as gender, marital status, and probable mode of transmission, represented as frequency tables and proportions, were analyzed with Pearson's chi-square test or Fisher's exact test. A framework analysis with the help of social cognitive theory was conducted to analyze the barriers to presenting for HIV care.

Result: The prevalence of late presentation to HIV care was 77.6%. The most probable mode of transmission was sexual contact among early and LPs. Age, marital status, and type of sexual contact were found to be associated with late presentation. The barriers to timely presentation for HIV care were identified as personal, behavioral, and environmental factors, which were interrelated.

Conclusion: Regular testing of HIV in asymptomatic high-risk groups, extensive social and behavioral change communication to improve awareness, and new initiatives to sensitize healthcare professionals to enable them to provide better HIV care are necessary for the timely identification of PLHIV.

Keywords: barriers to care; cd4 t-cells; hiv aids; hiv care; late presentation.

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Conflict of interest statement

Human subjects: Consent for treatment and open access publication was obtained or waived by all participants in this study. Institutional Ethics Committee, All India Institute of Medical Sciences, Rishikesh issued approval AIIMS/IEC/21/540. Animal subjects: All authors have confirmed that this study did not involve animal subjects or tissue. Conflicts of interest: In compliance with the ICMJE uniform disclosure form, all authors declare the following: Payment/services info: The study was supported by the Indian Council of Medical Research, Government of India, through financial assistance for a postgraduation thesis under Grant No: MD21DEC-0089. Financial relationships: All authors have declared that they have no financial relationships at present or within the previous three years with any organizations that might have an interest in the submitted work. Other relationships: All authors have declared that there are no other relationships or activities that could appear to have influenced the submitted work.

Figures

Figure 1
Figure 1. Probable mode of transmission among late presenters and early presenters
(A) Probable mode of transmission among late presenters; (B) Probable mode of transmission among early presenters
Figure 2
Figure 2. Opportunistic infections among the total study participants
^Others include one case each of pneumocystis pneumonia, toxoplasmosis, onchocerciasis, pelvic inflammatory disease (PID), and scabies.
Figure 3
Figure 3. Diagrammatic representation of barriers to presenting for HIV care as per the social cognitive theory
The solid-thick arrow shows the interrelation between the three main components or themes of social cognitive theory; the solid-thin arrows show the subthemes that fall under each of these themes, and the dotted arrows depict the interconnection between various subthemes. Credit: Image created by the authors
See this image and copyright information in PMC

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