Dorward et al [17]
|
South Africa
|
2398 HIV infected individuals
|
Cohort (2012–2015)
|
Length of time from the date of testing to linkage to care.
|
Age, gender, type of testing district, employment, level of education, household income, distance to the referral clinic, CD4 count at linkage, relationship status, HIV status disclosure
|
46% of participants linked to care within 365days of HIV testing; median time to linkage: 30days.
|
Younger age (≤ 30 years) (AHR: 0.58; 95% CI: 0.50–0.68), male gender (AHR: 0.86; 95% CI: 0.76–0.98), having diagnosis in the more urban district (AHR: 0.82; 95% CI: 0.73–0.93), being employed (AHR: 0.81; 95% CI: 0.72–0.92) were associated with decreased hazard of linkage-to-care; non-disclosure of HIV status had more impact on linkage to care in men (AHR: 0.53; 95% CI: 0.42–0.66) than women (AHR: 0.70; 95% CI: 0.60–0.82).
|
van der Kop et al [8]
|
Kenya
|
755 HIV infected individuals
|
Cross-sectional
|
Late presentation for care defined as first presentation with a CD4 count of < 200 cells/mm3 or at WHO stage IV.
|
Age, gender, education, travel time to a clinic, alcohol use, illicit drug use
|
Median time to presentation after first HIV testing: 22 days in those with advanced HIV; 19 days in those without advanced HIV.
|
Age ≥ 30 years was associated with presenting to care with advanced HIV compared to age < 30 years (AOR: 1.72; 95% CI: 1.45–2.03).
|
Gelaw et al [67]
|
Ethiopia
|
147 cases and 295 controls
|
Case-control
|
Cases: HIV infected individuals with CD4 count < 350 cell/mm3 or WHO stage III/IV at first clinical visit. Controls: HIV infected people with CD4 count ≥ 350 cell/mm3 or WHO stage I/II.
|
Age, gender, marital status, education, occupation, residence, pregnancy, number of sexual partners, wealth index, HIV status disclosure to a partner, year of presentation, house hold social support, illness as a cause for presentation to care, stigma and fear of losing a job
|
_ |
Age between 25–29 years (AOR:3.0; 95%CI:1.15–8.12) and 30–34 years (AOR:4.1; 1.35–12.46), having multiple sexual partners (AOR:6.0; 95%CI:1.28–28.02), lower wealth index (AOR:3.3; 95%CI:1.31–8.46), non-disclosure of HIV status to a partner (AOR:2.0; 95%CI: 1.05–4.14), low house hold social support (AOR:2.3; 95%CI:1.26–4.30), severity of illness as a cause for presentation for care (AOR:4.3; 95%CI: 2.26–8.0), fear of stigma (AOR:4.4; 95%CI: 2.2–8.3) and fear of losing a job (AOR:6.8; 95%CI:1.8–24.54) were independent risk factors for late presentation for HIV care.
|
Moreira et al [68]
|
Cape Verde
|
191 cases and 177 controls
|
Case-control
|
Cases: HIV infected individuals presenting for care with CD4 count < 350 cells/mm3.
Controls: HIV infected individuals presenting for care with CD4 count ≥ 350 cells/mm3.
|
Age, gender, level of education, employment, marital status, reason for HIV testing, status disclosure and distance to a health facility
|
_ |
Older age (≥ 60 years) (AOR: 3.19; 95%CI: 1.16–8.78) and medical indication for HIV testing (AOR: 4.84; 95%CI: 2.99–7.84) were associated with late presentation for care.
|
Gesesew et al [11]
|
Ethiopia
|
4900 HIV infected individuals
|
Cohort (2003–2015)
|
Late presentation for care defined as presentation with CD4 count < 200 cells/mm3 if enrolled between 2003 and 2011 and < 350 cells/mm3 if enrolled between 2012 and 2015 or WHO clinical stage III/IV in both periods.
|
Age, gender, marital status, educational status, religion, TB/HIV co-infection, baseline functional status and a history of HIV testing,
|
Late presentation for care in 66.7% overall.
|
Females (AOR:1.2; 95% CI: 1.03–1.5), TB/HIV co-infected patients (AOR:1.6; 95% CI: 1.09–2.1) and patients without a previous history of HIV testing (AOR:1.2; 95%CI: 1.1–1.4) were more likely to be presented late for care whereas older patients (25–50 years and 50 + years) compared to younger patients (15–24 years) (AOR: 0.4; 95% CI: 0.3–0.6) (AOR: 0.4; 95% CI: 0.2–0.6) were less likely to be presented late for care.
|
Kayabu et al [58]
|
Tanzania
|
1096 HIV infected individuals
|
Cross-sectional
|
Enrolment in care within 3-months of first HIV positive test.
|
Age, gender, marital status, baseline CD4 count, WHO stage and referral site
|
91% of participants enrolled in care within 3-months of HIV diagnosis.
|
Having a CD4 count of 50–199 cells/mm3 (AOR: 3.11; 95%CI: 1.14–8.50) was associated with more likelihood of linkage to care.
|
Luma et al [44]
|
Cameroon
|
1866 HIV infected individuals
|
Cohort (1996–2014)
|
Late presentation for HIV care defined as presentation with a CD4 count of < 350 cells/mm3 or WHO stages III/IV.
|
Age, gender, occupation, employment, religion, marital status, residence and circumstance of diagnosis
|
Late presentation for care in 89.7% overall.
|
Students compared to employed people (AOR: 0.50; 95%CI: 0.26–0.98) and those who were diagnosed through routine screening compared to clinical suspicion (AOR: 0.13; 95%CI: 0.10–0.19) were less likely to be late presenters for care.
|
Cholera et al [54]
|
South Africa
|
340 HIV infected individuals
|
Cross-sectional
|
Linkage to HIV care defined as obtaining a CD4 count result within 3-months of diagnosis.
|
Depression, age, gender, employment, alcohol use, perceived health status and baseline CD4 count
|
Linkage to care in 80% of depressed patients and in 73% of non-depressed patients.
|
Depression was not associated with linkage to care (RR: 1.08; 95%CI: 0.96, 1.23).
|
Kulkarni et al [23]
|
Ethiopia
|
831 HIV infected individuals
|
Cross-sectional
|
Time between initial HIV-positive diagnosis and enrolment in care.
|
Repeated HIV testing
|
Median time to be linked to care: 12.3 months in repeat testers; 1-month in single testers.
|
Repeated HIV test was associated with delay in linkage to care; >1 year delay time in 15% of single testers whereas in 51% of repeat testers (P < 0.001).
|
Maughan-Brown et al [56]
|
South Africa
|
86 HIV infected individuals
|
Cross-sectional
|
Linkage to care defined as a visit to a health facility within 3-months of diagnosis.
|
Readiness for treatment, alcohol use, perceived stigma, belief about ARV side-effects, denial of being HIV-positive and HIV status disclosure
|
67% of participants linked to care within 3-months.
|
Disclosing HIV status to someone other than a sexual partner (AOR: 2.99; 95%CI: 1.13–7.91) and treatment readiness (AOR: 2.97; 95%CI: 1.05–8.34) were associated with more likelihood of linkage to care; people who reported good health (AOR: 0.35; 95% CI: 0.13–0.99), those who drank alcohol at least once weekly (AOR: 0.35; 95%CI: 0.12–0.98) and those who reported experiencing internalised stigma (AOR: 0.32; 95% CI: 0.11–0.91) were less likely to be linked to care.
|
Teklu et al [20]
|
Ethiopia
|
4159 HIV infected individuals
|
Cohort (2005–2013)
|
Time from HIV testing to enrolment in care.
|
Age, gender, baseline WHO stage and CD4 count and HIV status disclosure
|
75% of participants enrolled in care within one week.
|
More care linkage time was observed in people with a higher CD4 count (> 349 cells/mm3) (AOR: 1.77; 95%CI: 1.37–2.27).
|
Maheu-Giroux et al [27]
|
South Africa
|
1733 HIV infected individuals
|
Cohort study (2004–2013)
|
Time from HIV infection (estimated as time between previous negative test and first positive test) to linkage to care.
|
Age, gender, education, food security, socioeconomic status, residence, distance to a clinic, knowledge of HIV status and presence of a household member on ART
|
4.9 years for 50% of HIV seroconverters.
|
People of age 40–49 years (AOR: 1.54; 95%CI: 1.14–2.08) and those who were aware of their HIV status from previous testing (AOR: 1.35; 95%CI: 1.09–1.68) were more likely to be linked to care whereas males were less likely to be linked to care compared to women (AHR: 0.49; 95%CI: 0.37–0.64).
|
Sanga et al [45]
|
Tanzania
|
1012 HIV infected individuals
|
Cohort (2014–2015)
|
Time to linkage to care since HIV diagnosis.
|
Age, gender, marital status, time required to reach a clinic, testing site, presence of family member taking ARVs, reason for diagnosis and status disclosure
|
78% of participants linked to care within 6-months; 84% for those tested at health facility; 69% for those tested at mobile sites.
|
Having HIV diagnosis at a health facility (AHR: 1.78; 95%CI: 1.52–2.07), disclosure of HIV status (AOR: 2.64; 95%CI: 2.05–3.39) and intention to get treatment as a reason for diagnosis (AOR: 1.25; 95%CI: 1.06–1.45) were associated with more likelihood of linkage to care.
|
Franse et al [66]
|
Rwanda
|
403 HIV infected individuals
|
Cluster non-randomised trial
|
Linkage to care defined as presentation to ART clinic within 90 days of HIV diagnosis.
|
Age, gender and the department where diagnosis was made
|
Linkage to care in 36.5% overall.
|
None of the variables were associated with linkage to care.
|
Reddy et al [19]
|
Tanzania
|
240 HIV infected individuals
|
Cohort (2008–2013)
|
Linkage to care within 6-months of diagnosis.
|
Age, gender, education, marital status, testing site, depression, stigma, social support, residence, occupation, wealth index and reason for testing
|
70.4% of participants linked to care within 6-months; 17.1% delayed more than 6 months.
|
Having HIV diagnosis at community sites (AOR: 2.89; 95%CI: 1.79–4.66) was associated with delayed or no linkage to care, but testing due to illness had a protective effect (AOR: 0.58; 95%CI: 0.34–0.96).
|
Takah et al [57]
|
Cameroon
|
223 HIV infected individuals
|
Cross-sectional
|
Delayed linkage to care defined as not having a CD4 count measurement within 3-months of HIV diagnosis.
|
Age, gender, religion, marital status, educational level, status disclosure, residence, time taken to reach ART site, alcohol use and presence of chronic diseases
|
Delays in linkage to care in 22.4% overall.
|
Higher CD4 count (> 500cells/mm3) (AOR: 3.60; 95%CI: 0.60–10.40) and lower WHO stages (I/II) (AOR: 5.40; 95%CI: 1.90 − 15.20) were associated with delayed linage to care.
|
Kwobah et al [15]
|
Kenya
|
10533 HIV infected individuals
|
Cross-sectional
|
Late engagement in care defined as having a baseline CD4 count ≤ 100 cells/mm3.
|
Age, gender, baseline CD4 count, travel time to clinic, education, disclosure status, economic status, social support, alcohol use, psychiatric illness, TB infection and point of entry into care
|
Late engagement in care in 23% overall.
|
Male gender (AOR: 1.54; 95%CI: 1.35–1.75), age > 24 years (AOR: 1.62; 95%CI: 1.02–2.56), more than 1-hour travel time to a clinic (AOR: 1.18; 95%CI: 1.04–1.34), having TB infection (AOR: 2.77; 95%CI: 2.40–3.19) and accessing care through home-based counselling and testing services (AOR: 2.98; 95%CI: 2.15–4.13) were associated with late engagement in care.
|
Nyika et al [69]
|
Zimbabwe
|
134 cases and 134 controls
|
Case-control
|
Cases: HIV infected individuals with a baseline CD4 of < 200/mm3 or WHO clinical stage III/IV. Controls: HIV infected individuals with a baseline CD4 of ≥ 200/mm3 or WHO clinical stage I/II.
|
Age, gender, marital status, residence, monthly income, education, religion, reason for HIV testing, stigma and receipt of HIV information
|
_ |
Male gender (AOR:7.68; 95%CI: 4.08–14.75), having HIV diagnosis due to illness (AOR:2.99; 95%CI:1.54–5.79) and stigma (AOR:2.99:95%CI:1.54–5.79) were associated with late presentation for care; receiving information on HIV (AOR:0.37; 95%CI: 0.18–0.78) and earning a monthly income of > USD250 (AOR:0.32; 95%CI: 0.76 − 0.67) had a protective effect.
|
Billioux et al [46]
|
Uganda
|
3666 HIV infected individuals
|
Cohort (2013–2015)
|
Linkage to care defined as completing
at least one clinic visit and/or self-reported use of
Cotrimoxazole/ART.
|
Age gender, education, marital status, religion, occupation, income and community type
|
Linkage to care in 74% overall.
|
Males (APRR: 0.84; 95%CI: 0.77–0.91), people of younger age (15–24 years) (APRR: 0.72; 95%CI: 0.63–0.82) and those who have never married (APRR: 0.84; 95%CI: 0.71–0.99) were less likely to be enrolled in care.
|
Boeke et al [47]
|
Uganda
|
928 HIV infected individuals
|
Cohort (2015–2016)
|
Linkage to care defined as registering for pre-ART or ART care within 1-month of HIV diagnosis.
|
Age, gender, facility and location
|
Linkage to care in 53% overall.
|
Linkage to care was lower in rural health facilities compared to urban health facilities (AOR: 0.64; 95%CI: 0.43–0.95) and in adolescents (age 10–18 years) compared to adults (age 19–48 years) (AOR: 0.58; 95%CI: 0.35–0.96).
|
Fomundam et al [7]
|
South Africa
|
8138 HIV infected individuals
|
Cross-sectional
|
Late presentation for HIV care refers to diagnosis at CD4 count ≤ 500 cells/mm3 and/or at any of the WHO stages.
|
Age, gender and facility location
|
Late presentation for car in 78% overall.
|
Higher likelihood of late presentation for care in males (AOR:2.73; 95%CI:1.50–4.94), people of older age (> 40 years) (AOR: 2.72; 95%CI: 2.02–3.66) and in those accessing care from urban health facilities (AOR:1.59; 95%CI: 1.34–1.90)
|
Honge et al [48]
|
Guinea-Bissau
|
3720 HIV infected individuals
|
Cohort (2005–2013)
|
Late presentation for care defined as presentation with a CD4 count below 200 cells/mm3.
|
Age, gender, marital status and education
|
Late presentation for care in 49% overall.
|
Male gender (AOR: 1.49; 95%CI: 1.24–1.80), having no partner (AOR: 1.30; 95%CI: 1.05–1.61) and age > 30 years (AOR: 1.66; 95%CI: 1.36–2.02) were risk factors for late presentation for care.
|
Lopez-Varela et al [49]
|
Mozambique
|
1112 HIV infected individuals
|
Cohort (2014–2015)
|
Linkage to care defined as having a first CD4 count available within 3-months of diagnosis.
|
Age, gender, clinical stage and testing
modality
|
Linkage to care in 74% overall.
|
Older age (> 35 years) (ASHR: 2.17; 95%CI:1.56–3.01), having a previous negative HIV test (ASHR: 1.43; 95%CI:1.16–1.76) and advanced WHO stage (stage III/IV) (ASHR:1.46; 95%CI:1.14–1.87) were positively associated with linkage to care whereas HBT (ASHR: 0.62; 95%CI: 0.47–0.83) and PICT(ASHR: 0.76; 95%CI: 0.61–0.94) were negatively associated with linkage to care compared to VCT.
|
Rane et al [50]
|
South Africa
|
1271 HIV infected individuals
|
Cohort (2013–2016)
|
Delayed presentation for care defined as a gap of > 90 days between the first HIV-positive test and study enrolment.
|
Age, gender, stigma, depression and anxiety
|
_ |
Severe depression (AOR: 3.6; 95%CI: 1.2–10.2) and anxiety (AOR: 2.3; 95%CI: 1.3–4.2) were associated with delayed presentation for care.
|
Rentsch et al [12]
|
Tanzania
|
411 HIV infected individuals
|
Cohort (2014–2017)
|
Linkage to care defined as first visit to the treatment centre within 90 days of diagnosis.
|
Age, gender and distance to a health facility
|
Linkage to care in 23.8% overall; 52.7% in those who were diagnosed using VCT; 17.7% in PICT cases; 10.2% in CBSS cases.
|
Higher hazards of linkage to care was observed in facility-based VCT compared to community-based sero-survey (AHR:
6.95; 95%CI: 4.39–11.00) and in individuals whose house is < 1km away from the treatment centre compared to that ≥ 5km (AHR: 4.67; 95%CI: 1.16–18.76).
|
Lifson et al [59]
|
Ethiopia
|
1799 HIV infected individuals
|
Cross-sectional
|
Advanced HIV disease (defined as CD4 count < 200 cells/mm3 or WHO stage III/IV) at enrolment to care.
|
Age, gender, marital status and occupation
|
Advanced HIV disease in 60% overall; 66% in males and 56% in females.
|
Male gender (P < 0.001) and unemployment (P < 0.001) were significantly associated with an advanced HIV disease; individuals of age ≤ 25 years were less likely to have an advanced HIV disease (P = 0.002).
|
Hoffman et al [70]
|
South Africa
|
459 HIV infected individuals
|
Cohort (2010–2013)
|
Linkage to care defined as return to a clinic for CD4 count results within 3-months of diagnosis.
|
Age, gender, marital status, education, employment, stigma, disclosure, depression, coping strategy, travel time to a clinic, baseline WHO stage and belief in ART safety and efficacy
|
Linkage to care in 54.1% overall.
|
Age < 30 years (AOR: 0.52; 95%CI: 0.33–0.82), holding positive-outcome belief in care (AOR: 0.50; 95%CI: 0.33–0.75), belief in ART efficacy (AOR: 0.29; 95%CI: 0.14–0.61), positive reframing as a coping strategy (AOR: 0.74; 95%CI: 0.55–0.99) and disclosure of HIV status (AOR: 0.40; 95%CI: 0.21–0.75) were associated with lower odds of non-linkage to care.
|
Maughan-Brown et al [60]
|
South Africa
|
183 HIV infected individuals
|
Cross-sectional
|
Linkage to care defined as first visit to an HIV clinic within 12-weeks of HIV testing.
|
Age, gender, education, monthly income, marital status, previous HIV diagnosis, baseline CD4 count, stigma, HIV status disclosure, depression and emotional support
|
Linkage to care in 55% overall.
|
Thinking that test results were wrong was associated with lower odds of linkage to care (AOR: 0.46; 95%CI: 0.23–0.93) whereas disclosure of HIV status to someone increased the likelihood of care linkage (AOR: 2.31: 95%CI: 1.07–4.97).
|
Haskew et al [61]
|
Kenya
|
1752 HIV infected individuals
|
Cross-sectional
|
Late linkage to care defined as having WHO stage III/IV or CD4 count ≤ 350 cells/mm3 at first clinic visit.
|
Age, gender, marital status and HIV testing source
|
Late linkage to care in 27.3% overall based on WHO stage and 65.5% based on CD4 count.
|
Having HIV test via VCT compared to community-based testing (AOR: 2.39; 95%CI: 1.24–4.60), being male (AOR: 1.38; 1.04–1.83), being divorced/widowed (AOR: 1.55; 95%CI: 1.15–2.08) and being in the age group of < 50 years (AOR: 1.72; 95%CI: 1.09–2.74) were significantly associated with late linkage to care.
|