# Proportion of Late Presenters to HIV Care and Barriers to Early Presentation: A Mixed-Methods Study at a Tertiary Care Hospital in Uttarakhand, India

## TL;DR

This study in India finds that most people with HIV seek care too late, and identifies personal, behavioral, and environmental barriers to early diagnosis.

## Contribution

A mixed-methods analysis of late HIV presentation in India, identifying specific barriers and associated factors.

## Key findings

- 77.6% of HIV patients presented late for care.
- Late presentation was associated with age, marital status, and type of sexual contact.
- Barriers to early HIV care include personal, behavioral, and environmental factors.

## Abstract

Introduction: Late presentation to HIV care and delay of people living with HIV (PLHIV) linkage to ART continue to be a challenge in many countries of the world, including India. It has an adverse impact on the health of the patient and the outcome of antiretroviral therapy (ART) programs. In this study, we assessed the proportion of late presenters (LPs), factors associated with late presentation among PLHIV, and barriers to early presentation for HIV care among LPs in a tertiary center in India.

Methodology: A sequential mixed-method study in which the quantitative part was conducted among 156 PLHIV receiving treatment at the ART center of All India Institute of Medical Sciences, Rishikesh, India. It was followed by a qualitative study with in-depth interviews of LPs. Continuous variables such as age and CD4 count were presented as median and interquartile range (IQR) and analyzed using the Mann-Whitney U test. Categorical variables such as gender, marital status, and probable mode of transmission, represented as frequency tables and proportions, were analyzed with Pearson’s chi-square test or Fisher's exact test. A framework analysis with the help of social cognitive theory was conducted to analyze the barriers to presenting for HIV care.

Result: The prevalence of late presentation to HIV care was 77.6%. The most probable mode of transmission was sexual contact among early and LPs. Age, marital status, and type of sexual contact were found to be associated with late presentation. The barriers to timely presentation for HIV care were identified as personal, behavioral, and environmental factors, which were interrelated.

Conclusion: Regular testing of HIV in asymptomatic high-risk groups, extensive social and behavioral change communication to improve awareness, and new initiatives to sensitize healthcare professionals to enable them to provide better HIV care are necessary for the timely identification of PLHIV.