HIV/AIDS late presentation and its associated factors in China from 2010 to 2020: a systematic review and meta-analysis

Abstract

Background: Late presentation to HIV/AIDS care presents serious health concerns, like increased transmission and high healthcare costs, increased mortality, early development of opportunistic infection, increased risk of antiretroviral therapy drug resistance. Despite the effort to contain the HIV/AIDS epidemic, LP has remained an impediment to individual immune reconstitution and public health.

Objective: This review aimed to estimate the prevalence and determine the factors associated with late presentation to HIV/AIDS care.

Methods: We searched PubMed, Web of Science, China National Knowledge Infrastructure (CNKI), Chinese Wanfang, and Weipu database for articles published from 2010 to 2020. We utilized I² statistics and Q-test to estimate heterogeneity between studies. Random-effects meta-analysis models were used to calculate the aggregate odds ratio of late presentation to HIV/AIDS care.

Results: Of 9563 titles and abstracts retrieved, 189 were identified as potentially eligible and 39 fulfilled the inclusion criteria. The pooled prevalence of late presentation to HIV/AIDS care was 43.26%. The major risk factors were patients ≥ 50 years old (OR = 2.19, 95% CI: 1.85-2.58; I² = 97.44%), married (OR = 1.50, 95% CI: 1.35-1.68; I² = 96.58%), with heterosexual contact as risk factor for infection (OR = 1.91, 95% CI: 1.73-2.11; I² = 90.74%) and diagnosed in medical institutions (OR = 2.35,95% CI: 2.11-2.62; I² = 96.05%). In middle or low HIV prevalence areas, patients ≥ 50 years old (P = 0.01), married (P < 0.01) and diagnosed in medical institutions (P = 0.01) were more likely to be presented late than in high prevalence areas. From 2016-2020, the OR of patients who were married and diagnosed in medical facilities were significantly lower than before (P < 0.01).

Conclusion: Patients ≥ 50 years old, married, with heterosexual contact as risk factor for infection, and diagnosed in medical institutions were risk factors of LP. Gender had no significant relationship with LP. In middle or low prevalence areas, patients who were ≥ 50 years old, married, and diagnosed in medical institutions were more likely to be presented late than in other areas. Married patients and those diagnosed in medical institutions after 2015 have a lower risk of LP than before.

Keywords: Associated factors; China; HIV/AIDS care; Late presentation; Meta-analysis.