# Barriers to Care for Newly Diagnosed HIV Patients: Insights From a Single-Centre Study

## TL;DR

This study identifies barriers to early HIV care and finds that late presentation is common, with preventable issues in healthcare consultations contributing to poor outcomes.

## Contribution

The study provides insights into preventable adverse events and barriers to care in a single-center HIV patient cohort.

## Key findings

- Late presenters made up 89.2% of newly diagnosed HIV patients, with 56.9% presenting with opportunistic infections.
- 9.9% of late presenters experienced preventable adverse events during healthcare consultations.
- Mortality was 5.9%, all among late presenters, highlighting the risks of delayed care.

## Abstract

Introduction: We aimed to evaluate the clinical presentation and diagnosis process of all newly diagnosed human immunodeficiency virus (HIV) patients and conduct a ‘look back' for barriers to care to aid a greater understanding of interventions to reduce late presentation.

Methods: We evaluated 102 patients with newly diagnosed HIV who were referred to Melaka Hospital's infectious disease (ID) team from January 2021 to December 2022 via retrospective case record review. They were categorised into late presenters (LPs) and nonlate presenters (NLPs). LP is defined as persons presenting for care with a cluster of differentiation 4 (CD4) count below 350 cells/μL or presenting with an acquired immunodeficiency syndrome (AIDS) defining event, regardless of the CD4 cell count. Demographic characteristics, individual and healthcare system barriers and treatment outcomes were evaluated.

Results: There were 89.2% of LPs, with 56.9% presenting with opportunistic infection (OI). Median CD4 for LPs upon diagnosis was 53 cells/μL. Pneumocystis jirovecii pneumonia was the most common presenting OI. Most were men who had sex with men (MSM) with more university graduates among the NLPs compared to LPs (36.4% vs. 8.8%, p 0.02). 9.9% of LPs experienced pitfalls during healthcare consultation, leading to late presentation, which was labelled as adverse events. LP's median time from diagnosis to first ID consultation was 7 days, and all patients' median duration of antiretroviral therapy (ART) initiation was 24 days. 82.4% of the patients were still on follow-up, with 69.6% achieving virological suppression at 6 months of ART. The mortality rate was 5.9%, all of which were LPs, and most were MSM.

Conclusions: Late presentation remains challenging, with 9.9% of potent preventable adverse events. Morbidity meetings are crucial for immediate feedback to involved healthcare providers. Community-based organisations also play an essential role in identifying and providing linkage of high-risk groups to early HIV screening and diagnosis.