The epidemiology and risk factors of delayed diagnosis in newly reported HIV/AIDS cases in Xuhui District,Shanghai,2018?2022
[Objective]To investigate the trends and significant determinants of delayed HIV diagnosis(DHD)among newly reported HIV/AIDS cases in Xuhui District,Shanghai between 2018 and 2022.[Methods]In the newly reported HIV/AIDS cases,patients died within one year without accident,HIV/AIDS cases with CD4 cell count<200 cells·μL-1,and AIDS cases with a CD4 cell count between 200 to 499 cells·μL-1 were defined as delayed diagnosis.Univariate and multivariate logistic analysis were employed to explore the influencing factors of DHD.[Results]Among the 862 newly reported HIV/AIDS cases,The DHD rate was 39.79%without statistically significant difference by year(χ2=4.508,P=0.342).Patients with CD4 cell count<200 cells·μL-1 contributed the largest proportion of DHD.During 2018‒2022,the DHD rate declined among HIV/AIDS patients who were younger than 35 years old or 45‒65 years old,never married,original diagnosis from tertiary specialized hospitals.Patients who were 65 years or older,married or divorced,with heterosexual transmitted HIV/AIDS,and original diagnosis from other types of testing and tertiary metropolitan hospital,had sustainably higher DHD rates.The number of HIV screening and diagnosed from voluntary counseling and testing(VCT)decreased during the COVID-19 epidemic,while the DHD rate increased sharply.Multivariate logistic regression analysis suggested the DHD rates were higher among older age,other types of testing(OR=3.805,95%CI:2.260‒6.406)and pre-operative testing(OR=2.411,95%CI:1.424‒4.081).Patients who received CD4 test in 15 days had a higher DHD rate compared to the cases received CD4 test exceeding 90 days(OR=0.336,95%CI:0.216‒0.522).[Conclusion]There is no significant decrease of delayed HIV diagnosis rate in Xuhui District in recent years,and the number of HIV tests has decreased in 2022.Monitoring of newly reported HIV/AIDS should be conducted continuously.Expansion of HIV antibody screening should be conducted in non-infectious departments and inpatient departments in healthcare institutions,particularly metropolitan hospitals.Assistance should be provided to clinicians and elderly patients for improving their ability to recognize and perceive the risk of HIV/AIDS,in order to enhance early diagnosis and subsequent treatment.
AIDSHIV late presentationrisk factorcross-sectional studymedical institution
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