Delayed HIV diagnosis and initiation of antiretroviral therapy
- 24 September 2014
- journal article
- research article
- Published by Ovid Technologies (Wolters Kluwer Health) in AIDS
- Vol. 28 (15), 2297-2306
- https://doi.org/10.1097/qad.0000000000000410
Abstract
Objectives:In Europe and elsewhere, health inequalities among HIV-positive individuals are of concern. We investigated late HIV diagnosis and late initiation of combination antiretroviral therapy (cART) by educational level, a proxy of socioeconomic position.Design and methods:We used data from nine HIV cohorts within COHERE in Austria, France, Greece, Italy, Spain and Switzerland, collecting data on level of education in categories of the UNESCO/International Standard Classification of Education standard classification: non-completed basic, basic, secondary and tertiary education. We included individuals diagnosed with HIV between 1996 and 2011, aged at least 16 years, with known educational level and at least one CD4(+) cell count within 6 months of HIV diagnosis. We examined trends by education level in presentation with advanced HIV disease (AHD) (CD4(+) <200cells/l or AIDS within 6 months) using logistic regression, and distribution of CD4(+) cell count at cART initiation overall and among presenters without AHD using median regression.Results:Among 15414 individuals, 52, 45,37, and 31% with uncompleted basic, basic, secondary and tertiary education, respectively, presented with AHD (P trend <0.001). Compared to patients with tertiary education, adjusted odds ratios of AHD were 1.72 (95% confidence interval 1.48-2.00) for uncompleted basic, 1.39 (1.24-1.56) for basic and 1.20 (1.08-1.34) for secondary education (P<0.001). In unadjusted and adjusted analyses, median CD4(+) cell count at cART initiation was lower with poorer educational level.Conclusions:Socioeconomic inequalities in delayed HIV diagnosis and initiation of cART are present in European countries with universal healthcare systems and individuals with lower educational level do not equally benefit from timely cART initiation.Keywords
This publication has 28 references indexed in Scilit:
- Risk Factors and Outcomes for Late Presentation for HIV-Positive Persons in Europe: Results from the Collaboration of Observational HIV Epidemiological Research Europe Study (COHERE)PLoS Medicine, 2013
- Late presentation of HIV infection: a consensus definitionHIV Medicine, 2010
- Understanding differences in health behaviors by educationJournal of Health Economics, 2010
- Medical and Societal Consequences of Late PresentationAntiviral Therapy, 2010
- Closing the gap in a generation: health equity through action on the social determinants of healthThe Lancet, 2008
- Delayed diagnosis of HIV infection and late initiation of antiretroviral therapy in the Swiss HIV Cohort StudyHIV Medicine, 2008
- Explaining income‐related inequalities in doctor utilisation in EuropeHealth Economics, 2004
- Factors Associated with Mortality in Human Immunodeficiency Virus Type 1–Infected Adults Initiating Protease Inhibitor–Containing Therapy: Role of Education Level and of Early Transaminase Level Elevation (APROCO–ANRS EP11 Study)The Journal of Infectious Diseases, 2002
- Educational level and mortality from infectious diseasesJournal of Epidemiology and Community Health, 2002
- Education and occupational social class: which is the more important indicator of mortality risk?Journal of Epidemiology and Community Health, 1998