Study area and period
The study was conducted in four selected public Hospitals of Mekelle city.
The study was conducted from March 18 to May 20/2019.
Institutional based unmatched case –control study was employed.
All HIV positive patients who enrolled to care in selected public hospitals of Mekelle city.
Cases: HIV positive individuals (≥18 years) with a baseline CD4 count of <200/uL or who had WHO clinical stage 3 or 4 at the time of first presentation (8).
Controls: HIV positive individuals (≥18 years) who had a baseline CD4 count of >200/uL or WHO clinical stage 1 or 2 at the time of first presentation.(8).
Inclusion and exclusion criteria
All HIV positive patients whose age is greater than 18 and who have follow up during data collection period.
Those who are newly diagnosed and unconscious patients was excluded.
Sample size determination and sampling technique
The sample size was calculated using open Epi-Info Version 188.8.131.52 statistical software by considering the assumptions for case control study. The sample was 104 cases and 208 controls. Accordingly, by adding 10% for the nonresponse rate the ultimate sample size was 114 cases and 229 controls a total of 343.
Sampling technique and Sampling procedure
First, the sample size was allocated proportionally to the four ART treatment centers of Mekelle public hospitals according to the number of patients registered to take the treatment and simple random sampling technique was used to select the ART cases and controls.
Presentation to HIV care
Socio-demographic factors: Age, sex, educational status , place of residence, marital Status, employment status, monthly income of participants , owner of the house ,transport fees, time taken to health facility they served.
Sociocultural factors: HIV disclosure status, history of alcohol consumption, Contact with commercial sex workers.
Heath system and provider factors : Challenge faced during care, prior HIV related teaching and information, treatment seeking anywhere before starting care.
Perceived Susceptibility and Perceived benefits: Perception of ART side effects, HIV as stigmatizing disease, stigma as barrier to HIV testing and starting care, benefit of early care.
Clinical factors: Time gap between testing and HIVcare enrollment, symptom during, presence of chronic illness. starting care ,reason for HIV testing, feeling of ill while starting care, information about HIV before starting care , counseling , support of health providers , recommendation of patients to other patients , member of support group ,overall quality service.
Time to present for HIV care: Presentation of the participants to HIV/AIDS care dichotomized as early and late.
Early presentation for HIV/AIDS care –:when HIV positive individuals (age 15 years and above) came with WHO stage I or II and a CD4 lymphocyte count of 200 cells/ µl or more at the time of first presentation to the ART clinics of the institution.
Late presentation from an immunological point of view is enrollment into HIV/AIDS care with a CD4 count of <200 cells/uL (9).
Enrollment into care is being entered into the Pre-ART register at a health facility and assigned an OI/ART number (9).
Clinically, late presentation is defined as enrolment into care with an AIDS defining illness as prescribed by the World Health Organization and is classified as Stage 3 and 4 (6).
Data collection tool and technique
Four data collectors (BSc nurses) and two supervisors (MScN) were selected and two days training was given them about the objectives of the study and how to approach the study participants. Then the data collectors were interviewed eligible and voluntary patients in a favorable place using structured questionnaire and the supervisors were supervised during the data collection process. The initial. English version of the questionnaire was translated to the local language Tigrigna and also translated back to English
Data quality control
Prior to data collection a two day training was be given by the principal investigator. Pre-test was conducted using 10% of the sample on HIV patients before two weeks to assess instrument simplicity, flow and consistency. The cleaning process was done by running simple frequency and cross tabulation after data entry for its consistency.
Data processing and analysis
The collected data was edited, checked visually for its completeness and the response was coded and entered in into the computer using SPSS version23 for entering and analyzing purpose. Descriptive statistics was computed and the result was summarized and presented by texts, tables, and grap.