Annual trends and risk factors of late presentation of HIV at 19 referral hospitals in Indonesia: findings from the INA-PROACTIVE cohort.
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Arlinda Dona, Yunihastuti Evy, Indrati Agnes Rengga, Merati Tuti Parwati, Papot Emmanuelle, Cromer Deborah, Diana Aly, Naysilla Adhella Menur, Dewantara Riza Danu, Susanto Nugroho Harry, Lukman Nurhayati, Adi Pranata I Wayan, Kosasih Herman, Lokida Dewi, Karyana Muhammad, Hartono Teguh Sarry, Rai Kosa I Gede, Theresia Deborah, Savitri Dwiana, Nugroho Dwi Kurniawan, Eppy Eppy, Susila Utama I Made, Jamil Kurnia Fitri, Toruan Ivan Lumban, Samosir Nelly Elfrida, Katu Sudirman, Farhanah Nur, Wahyunie Sri, Rusli Musofa, Swastika Widya Amalia, Ignatius Wullur Willy Anthony, Subronto Yanri Wijayanti, Liang C Jason, Ridzon Renee, Chen Ray Y, Neal Aaron T, INA-PROACTIVE Study Group
Аннотация
METHODS: Adult PLWH were enrolled at 19 centers across Indonesia (2018-2020) in the INA-PROACTIVE observational cohort study. Late presentation was defined as having a CD4+ count <350 cells/μl within 3 months of diagnosis. Risk factors were assessed using multivariable logistic regression.
FINDINGS: Among 3201 eligible participants, 2790 (87·2%) were late presenters. High proportion of late presenters was observed from 2015 to 2019 (83·3%-89·8%). Characteristics associated with late presentation included age 30-39 (aOR = 1·47, 95% CI: 1·15-1·90) or age ≥40 (aOR = 1·71, 95% CI: 1·21-2·46) vs. age 18-29; male sex (aOR = 2·93, 95% CI: 2·07-4·24); diagnosis in ≤2015 (aOR = 1·45, 95% CI: 1·12-1·89); and diagnosis through Provider-Initiated Testing and Counseling (aOR = 2·38, 95% CI: 1·86-3·04) vs. Voluntary Counseling and Testing (VCT). Suspected MSM transmission was associated with lower odds of late presentation (aOR = 0·57, 95% CI: 0·39-0·82) compared to heterosexual transmission.
INTERPRETATION: Late presentation remains highly prevalent in Indonesia. Expanded efforts are needed to promote testing among those at risk. Targeted interventions for older adults, men, and non-MSM populations, alongside VCT and MSM-focused programs, may help reduce late HIV diagnosis and improve early management.
FUNDING: This project has been funded in whole or in part with Federal funds from the National Institute of Allergy and Infectious Diseases, National Institutes of Health, under contract No. 75N91019D00024 Task orders 75N91020F00004, 75N91020F000012.