Predictors of Delayed Enrolment for Care among People Living with HIV in a Tertiary Hospital in South Eastern Nigeria

Abstract

Aim: This study aimed to identify predictors of delayed enrolment to HIV care in Calabar, Nigeria. Study Design: This was a cross sectional observational study. Place and Duration: This study was carried out in a tertiary level hospital in Calabar, Nigeria between February 1st, 2013 and June 30th, 2013. Methodology: We recruited 500 consecutive HIV-infected persons presenting to care for the first time following HIV diagnosis using a validated, semi-structured and pretested questionnaire. The outcome variable of interest was delayed enrolment for HIV care (>12 months after HIV diagnosis). The independent variables included age, sex, marital status, occupation, income, level of education and exposure to risky behaviour. Others were sexual orientation, duration between HIV testing and presentation for care, residential conditions, lack of spousal HIV status disclosure, distance of residence from nearest HIV care centre and being in a long-standing steady partnership. Results: A total of 45 (9.0%) of the participants enrolled for HIV care within twelve months of HIV diagnosis while 455 (91.0%) enrolled for care after 12 months of diagnosis. The average CD4+ count of those who enrolled early was 248cells/µl which was much lower than the average CD4+ count of those who delayed enrolment (310cells/µl). The average distance of participants who enrolled early for care was lower (296km) than those who delayed enrolment (346km). The covariates significantly associated with delayed enrolment on bivariate analysis were sex, occupation, alcohol use and CD4+ count. Three out of the four covariates retained their significance following multivariate logistic regression and they were CD4+ count, male sex and farming. Conclusion: A significant proportion of clients diagnosed with HIV infection delay in enrolling for care in Calabar. The predictors of delayed enrolment are CD4+ count, male sex and farming. A multifaceted approach of advocacy and social mobilization, poverty alleviation strategies and provision of effective health insurance for all is required.