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Significant association between perceived HIV related stigma and late presentation for HIV/AIDS care in low and middle-income countries: A systematic review and meta-analysis

Hailay Abrha Gesesew, Amanuel Tesfay Gebremedhin, Tariku Dejene Demissie and 3 more

PLOS ONE · 2017 · Meta-analysis · CC BY

doi:10.1371/journal.pone.0173928

Abstract

Background. Late presentation for human immunodeficiency virus (HIV) care is a major impediment for the success of antiretroviral therapy (ART) outcomes. The role that stigma plays as a potential barrier to timely diagnosis and treatment of HIV among people living with HIV/AIDS (acquired immunodeficiency syndrome) is ambivalent. This review aimed to assess the best available evidence regarding the association between perceived HIV related stigma and time to present for HIV/AIDS care.

Methods. Quantitative studies conducted in English language between 2002 and 2016 that evaluated the association between HIV related stigma and late presentation for HIV care were sought across four major databases. This review considered studies that included the following outcome: ‘late HIV testing’, ‘late HIV diagnosis’ and ‘late presentation for HIV care after testing’. Data were extracted using a standardized Joanna Briggs Institute (JBI) data extraction tool. Meta- analysis was undertaken using Revman-5 software. I2 and chi-square test were used to assess heterogeneity. Summary statistics were expressed as pooled odds ratio with 95% confidence intervals and corresponding p-value.

Results. Ten studies from low- and middle- income countries met the search criteria, including six (6) and four (4) case control studies and cross-sectional studies respectively. The total sample size in the included studies was 3,788 participants. Half (5) of the studies reported a significant association between stigma and late presentation for HIV care. The meta-analytical association showed that people who perceived high HIV related stigma had two times more probability of late presentation for HIV care than who perceived low stigma (pooled odds ratio = 2.4; 95%CI: 1.6–3.6, I2 = 79%).

Conclusions. High perceptions of HIV related stigma influenced timely presentation for HIV care. In order to avoid late HIV care presentation due the fear of stigma among patients, health professionals should play a key role in informing and counselling patients on the benefits of early HIV testing or early entry to HIV care. Additionally, linking the systems and positive case tracing after HIV testing should be strengthened.

References 78

1.
Estimates of global, regional, and national incidence, prevalence, and mortality of HIV, 1980–2015: the Global Burden of Disease Study 2015 · 2016
No notice
2.
Gardner EM, McLees MP, Steiner JF, del Rio C, Burman WJ. The Spectrum of Engagement in HIV Care and its Relevance to Test-and-Treat Strategies for Prevention of HIV Infection. Clinical Infectious Diseases. 2011; 52(6):793–800.
Not in our library10.1093/cid/ciq243
3.
Kranzer K, Govindasamy D, Ford N, Johnston V, Lawn SD. Quantifying and addressing losses along the continuum of care for people living with HIV infection in sub-Saharan Africa: a systematic review. Journal of the International AIDS Society. 2012; 15(2):17383
Not in our library10.7448/ias.15.2.17383
4.
Castilla J, Sobrino P, De La Fuente L, Noguer I, Guerra L, Parras F. Late diagnosis of HIV infection in the era of highly active antiretroviral therapy: consequences for AIDS incidence. AIDS (London, England). 2002; 16(14):1945–1951.
Not in our library10.1097/00002030-200209270-00012
5.
Girardi E, Aloisi MS, Arici C, Pezzotti P, Serraino D, Balzano R et al Delayed presentation and late testing for HIV: demographic and behavioral risk factors in a multicenter study in Italy. Journal of acquired immune deficiency syndromes (1999). 2004; 36(4):951–959.
Not in our library10.1097/00126334-200408010-00009
6.
Longo B, Pezzotti P, Boros S, Urciuoli R, Rezza G. Increasing proportion of late testers among AIDS cases in Italy, 1996–2002. AIDS care. 2005; 17(7):834–841.
Not in our library10.1080/09540120500038397
7.
Delpierre C, Dray-Spira R, Cuzin L, Marchou B, Massip P, Lang T et al Correlates of late HIV diagnosis: implications for testing policy. International journal of STD & AIDS. 2007; 18(5):312–317.
Not in our library10.1258/095646207780749709
8.
Santos J, Palacios R, Gutierrez M, Grana M, de la Torre J, Salgado F et al HIV infection in the era of highly active antiretroviral therapy: the Malaga Study. International journal of STD & AIDS. 2004; 15(9):594–596.
Not in our library10.1258/0956462041724253
9.
Mayben JK, Kramer JR, Kallen MA, Franzini L, Lairson DR, Giordano TP. Predictors of delayed HIV diagnosis in a recently diagnosed cohort. AIDS patient care and STDs. 2007; 21(3):195–204.
Not in our library10.1089/apc.2006.0097
10.
Antinori A, Coenen T, Costagiola D, Dedes N, Ellefson M, Gatell J et al Late presentation of HIV infection: a consensus definition. HIV medicine. 2011; 12(1):61–64.
Not in our library10.1111/j.1468-1293.2010.00857.x
11.
CDC. From the Centers for Disease Control and Prevention. 1993 revised classification system for HIV infection and expanded surveillance case definition for AIDS among adolescents and adults. Jama. 1993; 269(6):729–730.
Not in our library
12.
Mojumdar K, Vajpayee M, Chauhan NK, Mendiratta S. Late presenters to HIV care and treatment, identification of associated risk factors in HIV-1 infected Indian population. BMC public health. 2010; 10:416
Not in our library10.1186/1471-2458-10-416
13.
Alvarez-Uria Gerardo, Midde Manoranjan, Pakam Raghavakalyan, Kannan Shanmugamari, Bachu Lakshminarayana, Naik PK. Factors Associated with Late Presentation of HIV and Estimation of Antiretroviral Treatment Need according to CD4 Lymphocyte Count in a Resource-Limited Setting: Data from an HIV Cohort Study in India. Interdisciplinary Perspectives on Infectious Diseases. 2012; 2012:1–7.
Not in our library10.1155/2012/293795
14.
Gesesew HA, Tesfamichael FA, Adamu BT. Factors affecting late presentation for HIV care in Southwest Ethiopia: A case control study. Public Health Research. 2013; 3(4):98–107.
Not in our library
15.
Okome-Nkoumou M, Okome-Miame F, Kendjo E, Obiang GP, Kouna P, Essola-Biba O et al Delay between first HIV-related symptoms and diagnosis of HIV infection in patients attending the internal medicine department of the Fondation Jeanne Ebori (FJE), Libreville, Gabon. HIV Clin Trials. 2005; 6(1):38–42.
Not in our library10.1310/ulr3-vn8n-kkb5-05uv
16.
Kigozi IM, Dobkin LM, Martin JN, Geng EH, Muyindike W, Emenyonu NI et al Late-disease stage at presentation to an HIV clinic in the era of free antiretroviral therapy in Sub-Saharan Africa. Journal of acquired immune deficiency syndromes (1999). 2009; 52(2):280–289.
Not in our library10.1097/qai.0b013e3181ab6eab
17.
COHERE. Late presentation for HIV care across Europe: update from the Collaboration of Observational HIV Epidemiological Research Europe (COHERE) study, 2010 to 2013. Euro surveillance: bulletin Europeen sur les maladies transmissibles = European communicable disease bulletin. 2015; 20(47).
Not in our library10.2807/1560-7917.es.2015.20.47.30070
18.
Hachfeld A, Ledergerber B, Darling K, Weber R, Calmy A, Battegay M et al Reasons for late presentation to HIV care in Switzerland. Journal of the International AIDS Society. 2015; 18(1):20317.
Not in our library10.7448/ias.18.1.20317
19.
Gelaw YA, Senbete GH, Adane AA, Alene KA. Determinants of late presentation to HIV/AIDS care in Southern Tigray Zone, Northern Ethiopia: an institution based case–control study. AIDS Research and Therapy. 2015; 12:40
Not in our library10.1186/s12981-015-0079-2
20.
Peitzmeier SM, Grosso A, Bowes A, Ceesay N, Baral SD. Associations of Stigma With Negative Health Outcomes for People Living With HIV in the Gambia: Implications for Key Populations. Jaids-Journal of Acquired Immune Deficiency Syndromes. 2015; 68:S146–S153.
Not in our library10.1097/qai.0000000000000453
21.
Hatcher AM, Turan JM, Leslie HH, Kanya LW, Kwena Z, Johnson MO et al Predictors of linkage to care following community-based HIV counseling and testing in rural Kenya. AIDS and behavior. 2012; 16(5):1295–1307.
Not in our library10.1007/s10461-011-0065-1
22.
Onyango SA: Factors Associated with Late Diagnosis and Delayed Presentation of HIV/AIDS Patients at the Kenyatta Hospital Comprehensive Care Centre. Nairobi: Kenyatta University; 2009
Not in our library
23.
Abaynew Y, Deribew A, Deribe K. Factors associated with late presentation to HIV/AIDS care in South Wollo ZoneEthiopia: a case-control study. AIDS Res Ther. 2011; 8:8
Not in our library10.1186/1742-6405-8-8
24.
Krawczyk C, Funkhouser E, Kilby J, Kaslow R, Bey A, Vermund S. Factors Associated with Delayed Initiation of HIV Medical Care Among Infected Persons Attending a Southern HIV/AIDS Clinic. Southern medical journal. 2006; 99(5): 472–481.
Not in our library10.1097/01.smj.0000215639.59563.83
25.
Haskew J, Turner K, Rø G, Ho A, Kimanga D, Sharif S. Stage of HIV presentation at initial clinic visit following a community-based HIV testing campaign in rural Kenya. BMC public health. 2015; 15(1):1–7.
Not in our library10.1186/s12889-015-1367-4
26.
Dennis AM, Napravnik S, Seña AC, Eron JJ. Late Entry to HIV Care Among Latinos Compared With Non-Latinos in a Southeastern US Cohort. Clinical Infectious Diseases. 2011; 53(5):480–487.
Not in our library10.1093/cid/cir434
27.
Wolfe WR, Weiser SD, Bangsberg DR, Thior I, Makhema JM, Dickinson DB et al Effects of HIV-related stigma among an early sample of patients receiving antiretroviral therapy in Botswana. AIDS care. 2006; 18(8):931–933.
Not in our library10.1080/09540120500333558
28.
Govindasamy D, Ford N, Kranzer K. Risk factors, barriers and facilitators for linkage to antiretroviral therapy care: a systematic review. AIDS (London, England). 2012; 26(16):2059–2067.
Not in our library10.1097/qad.0b013e3283578b9b
29.
Goff Man E. Stigma: notes on the management of a spoiled identity. NewYork; 1963.
Not in our library
30.
Tran TTN, Mwanri L. Addressing Stigma and Discrimination in HIV/AIDS Affected Orphans and Vulnerable Children in Vietnam. World Journal of Preventive Medicine. 2013; 1(3):30–35.
Not in our library
31.
Derlega VJ, Winstead BA, Greene K, Serovich J, Elwood WN. Perceived HIV-related Stigma and HIV Disclosure to Relationship Partners after Finding Out about the Seropositive Diagnosis. Journal of health psychology. 2002; 7(4):415–432.
Not in our library10.1177/1359105302007004330
32.
Peter A, Kate W, Anne M, Richard P: HIV Related Stigam, Discrimination and Human Rights Violations: CAse studies of successful program In. Ney York: Education, University of London, United Kingdom; 2005.
Not in our library
33.
Fauk N, Mwanri L. Economic and Environmental Determinants of Ojek's Susceptibility to HIV Infections. International Journal of Applied Pharmaceutical Sciences and Bio Medical Sciences. 2014; 3(1):291–300.
Not in our library
34.
Fauk K, Mwanri L. Individual and Contextual Risk Factors of The HIV Pandemic in Young Adults. A Case of School, College and University Students in China. International Journal of Research in Social Sciences,. 2014; 4(3):1–20.
Not in our library
35.
Fauk N, Mwanri L. Inequalities in addressing the HIV epidemic: the story of the Indonesian Ojek community. International Journal of Human Rights in Healthcare,. 2015; 8(3).
Not in our library
36.
Bonjour M, Montagne M, Zambrano M, Molina G, Lippuner C, Wadskier F et al Determinants of late disease-stage presentation at diagnosis of HIV infection in Venezuela: A case-case comparison. AIDS Research and Therapy. 2008; 5(1):1–12.
Not in our library10.1186/1742-6405-5-6
37.
Berger BE, Ferrans CE, Lashley FR. Measuring stigma in people with HIV: psychometric assessment of the HIV stigma scale. Research in nursing & health. 2001; 24(6):518–529.
Not in our library10.1002/nur.10011
38.
Gesesew HA, Gebremedhin AT, Demissie TD, Kerie MW, Sudhakar M. The association between perceived HIV-related stigma and presentation for HIV/AIDS care in developing countries: a systematic review protocol The JBI Database of Systematic Reviews and Implementation Reports. 2014; 12(4):60–68.
Not in our library
39.
Viswanathan M, Ansari MT, Berkman ND, Chang S, Hartling L, McPheeters M et al: AHRQ Methods for Effective Health Care: Assessing the Risk of Bias of Individual Studies in Systematic Reviews of Health Care Interventions In: Methods Guide for Effectiveness and Comparative Effectiveness Reviews. edn. Rockville (MD): Agency for Healthcare Research and Quality (US); 2008: 14.
Not in our library
40.
Nyika H, Mugurungi O, Shambira G, Gombe NT, Bangure D, Mungati M et al Factors associated with late presentation for HIV/AIDS care in Harare City, Zimbabwe, 2015. BMC public health. 2016; 16(1):369.
Not in our library10.1186/s12889-016-3044-7

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