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      Late Presentation and Missed Opportunities for HIV Diagnosis in Guatemala

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          Abstract

          Early HIV diagnosis remains a challenge in many regions with delayed diagnosis resulting in increased morbidity and mortality. We conducted a retrospective cohort study of people living with HIV receiving outpatient care at a large tertiary referral center in Guatemala to describe the proportion of late presenters (LP) and missed opportunities for HIV diagnosis. Of 3,686 patients, 2,990 (81.1%) were LP who were more likely male (60.2% vs. 48.0%, p<0.0001), heterosexual (88.0% vs. 78.0%, p<0.0001) and rural dwellers (43.7% vs. 33.8%. p<0.0001). The proportions of patients who presented late or with AIDS at diagnosis decreased over time. Only 665 patients (18.2%) sought care in the 2 years prior to HIV diagnosis. This study, the first of its kind in Central America to focus on late presenters and missed opportunities for HIV diagnosis, demonstrates extremely high rates of LP in Guatemala. Although in recent years rates of LP have improved somewhat, the need for screening outside of traditional healthcare settings is apparent.

          Resumen

          El diagnóstico precoz del VIH sigue siendo un desafío en muchas regiones, y un diagnóstico tardío está relacionado con aumento de la morbi-mortalidad. Este estudio retrospectivo de una cohorte de personas viviendo con VIH en seguimiento en un centro atención terciaria en ciudad de Guatemala, describe la proporción de presentadores tardíos (PT) y las oportunidades perdidas para diagnosticarlas. De 3,686 pacientes analizados, 2,990 (81.1%) eran PT, los cuales eran con mayor frecuencia varones (60.2% vs. 48.0%, p<0.0001), heterosexuales (88.0% vs. 78.0%, p<0.0001) y habitantes de un área rural (43.7% vs. 33.8%. p<0.0001). La proporción de PT disminuyó a lo largo del tiempo. Únicamente 665 pacientes (18.2%) buscaron atenciٕón médica en los dos años previos al diagnóstico del VIH. Este estudio, el primero en su clase en Centro América, demuestra una tasa extremadamente alta de PT en Guatemala. A pesar de que en años recientes la tasa de PT ha mejorado, es evidente la necesidad de realizar tamizaje fuera del ambiente sanitario habitual.

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          Author and article information

          Journal
          9712133
          21042
          AIDS Behav
          AIDS Behav
          AIDS and behavior
          1090-7165
          1573-3254
          5 July 2020
          April 2019
          03 August 2020
          : 23
          : 4
          : 920-928
          Affiliations
          [1 ]Infectious Diseases Clinic, Department of Internal Medicine, Roosevelt Hospital, Guatemala City, Guatemala
          [2 ]Department of Medicine, Washington University School of Medicine, St. Louis, MO
          [3 ]Division of Infectious Diseases, Washington University School of Medicine, St. Louis, MO
          Author notes
          [*]

          Deceased

          Corresponding Author Johanna Meléndez, MD, Internal Medicine and Infectious Disease, HIV Clinic at Roosevelt Hospital, Calzada Roosevelt, Guatemala, Guatemala, CP 01011, T: (502)2475.1138, F: (502)2445.4304, jrmm24@ 123456yahoo.com
          Alternate Corresponding Author Andrej Spec, MD, MSCI, Assistant Professor, Infectious Disease, Associate Director, Infectious Disease Clinical Research Unit, 4523 Clayton Ave., Campus Box 8051, St Louis, MO, 63110-0193, T: 314.747.1725, F: 314.454.8294, andrejspec@ 123456wustl.edu
          Article
          PMC7397713 PMC7397713 7397713 nihpa1608822
          10.1007/s10461-018-2331-y
          7397713
          30426264
          3b0a5cb9-6924-4301-9b3d-a0de16e6d3c6
          History
          Categories
          Article

          HIV,AIDS,Diagnosis,Guatemala
          HIV, AIDS, Diagnosis, Guatemala

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