Factors Associated with Advanced HIV Disease Among Recipients of Care Newly Enrolling in Mutare City Council Health Facilities, Zimbabwe in 2024

Abstract

Despite a significant increase in anti-retroviral therapy (ART) access in sub-Saharan Africa (SSA), between 15% and 30% of people living with HIV initiating ART had Advanced HIV Disease (AHD). According to routine program data from Zimbabwe, in 2023, 36% of individuals newly enrolled in ART had AHD. AHD is the biggest contributor of mortality among people living with HIV and needs to be identified early and managed appropriately. Mutare City is equally affected by a high proportion of AHD on enrolment, with a prevalence of 34% among those screened in 2023. Understanding the factors associated with having AHD at ART enrolment could assist in identifying interventions to reduce the proportion of individuals enrolling with AHD. A case control study was conducted in all 9 Mutare City health facilities to determine the prevalence of and the factors associated with AHD and assess the management of individuals with AHD. Cases were individuals enrolling with CD4 less than 200 or World Health Organization’s (WHO) clinical stage 3 or 4 condition while controls were those enrolling with CD4 above 200 or WHO stage 1 or 2. Demographic, behavioral, clinical and health system factors’ data was collected from 99 cases and 99 controls through virtual telephone interviews using a structured questionnaire and a data abstraction tool from facility patient records and registers. Data was analyzed using EpiInfo version 7.2.6.0 generating frequencies and averages. Association between individual risk factors and AHD was analyzed using Odds ratios while logistic regression analysis was used for multivariate analysis, identifying confounders. Based on Chi-square test, AHD was associated with being male (p=0.002), delayed linkage to treatment after HIV diagnosis (p<0.001)) and having a low HIV risk perception (p=0.003). There was a significant age difference between cases (mean = 38 years) and controls (mean = 33 years), p<0.001. Age, sex and HIV risk assessment were confounders of the association between ART linkage delay and AHD. Low HIV risk perception and delays in initiating lifelong ART after HIV diagnosis were significant risk factors for AHD, especially among males and older individuals. It is recommended that programs should strengthen interventions to improve HIV awareness, early testing and invest in robust mechanisms for tracking and early linking of individuals diagnosed with HIV to treatment. These interventions must target men and older individuals, who are at greatest risk of AHD.