ArticlePLOS global public health2022
Prevalence of and factors associated with late diagnosis of HIV in Malawi, Zambia, and Zimbabwe: Results from population-based nationally representative surveys.
Article in PLOS global public health, 2022. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 14 papers.
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Who cites it
14 citing papers in PubMed, 18 citations in OpenAlex.
- Advanced HIV disease among newly diagnosed clients identified through community- and facility-based HIV testing services in Eswatini: a cross-sectional study.Frontiers in public health · 2026Article
- Decreasing Adult Prevalence of Advanced HIV Disease From 2 Population-Based HIV Impact Assessments in Eswatini, Lesotho, Malawi, Tanzania, Uganda, Zambia, and Zimbabwe, 2015-2023.Open forum infectious diseases · 2026Article
- A Contemporary Multidimensional Insight into the Clinical and Pathological Presentation of Urological Conditions Associated with HIV: A Narrative Review.Tropical medicine and infectious disease · 2025Review
- Slow virologic control but strong immune and metabolic recovery with dolutegravir-anchored therapy in an HIV cohort in Ghana.Virology journal · 2025Article
- Identifying gaps in the HIV treatment cascade in Africa: a model comparison study.The Lancet. Global health · 2025Article
- Trend and Associated Factors for Late and Advanced HIV Diagnoses in 2011-2022 in Melbourne, Australia.Journal of medical virology · 2025Article
- Analysis of travel-time to HIV treatment in sub-Saharan Africa reveals inequities in access to antiretrovirals.Communications medicine · 2025Article
- Assessment of the HIV Enhanced Access Testing in the Emergency Department (HEATED) program in Nairobi, Kenya: a quasi-experimental prospective study.HIV research & clinical practice · 2024Article
- Implementation and Assessment of the HIV Enhanced Access Testing in the Emergency Department (HEATED) Program in Nairobi, Kenya: A Quasi-Experimental Prospective Study.medRxiv : the preprint server for health sciences · 2024Article
- Mortality and associated factors among people living with HIV admitted at a tertiary-care hospital in Uganda: a cross-sectional study.BMC infectious diseases · 2024Article
- Barriers and facilitators to implementing Advanced HIV Disease screening at secondary referral hospital -Malawi: Asequential exploratory mixed method-study.Research square · 2023Article
- Predictors of delayed Anti-Retroviral Therapy initiation among adults referred for HIV treatment in Uganda: a cross-sectional study.BMC health services research · 2023Article
- Outcomes of a model for re-testing HIV-negative index contacts in Sedibeng, South Africa.Southern African journal of HIV medicine · 2023Article
- Evolving Trends in Late HIV Diagnosis: Increasing Frequency but Improved Survival and Reduced Opportunistic Infections in a 10-Year Hospital-Based Cohort.Inquiry : a journal of medical care organization, provision and financingArticle
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Authors and funding
25 authors at 8 institutions in 6 countries.
Funding
Abstract
introductionLate diagnosis of HIV (LD) increases the risk of morbidity, mortality, and HIV transmission. We used nationally representative data from population-based HIV impact assessment (PHIA) surveys in Malawi, Zambia, and Zimbabwe (2015-2016) to characterize adults at risk of LD and to examine associations between LD and presumed HIV transmission to cohabiting sexual partners.
methodsWe estimated the prevalence of LD, defined as CD4 count <350 cells/μL, among adults newly diagnosed with HIV during the surveys and odds ratios for associated factors. We linked newly diagnosed adults (index cases) to their household sexual partners and calculated adjusted odds ratios for associations between LD of the index case, viral load of the index case, and duration of HIV exposure in the relationship, and the HIV status of the household sexual partner.
resultsOf 1,804 adults who were newly diagnosed with HIV in the surveys, 49% (882) were diagnosed late. LD was associated with male sex, older age, and almost five times the odds of having an HIV-positive household sexual partner (adjusted odds ratio [aOR], 4.65 [95% confidence interval: 2.56-8.45]). Longer duration of HIV exposure in a relationship and higher viral load of the index case were both independently associated with higher odds of having HIV-positive household sexual partners. Individuals with HIV exposure of more than 5 years had more than three times (aOR 3.42 [95% CI: 1.63-7.18]) higher odds of being HIV positive than those with less than 2 years HIV exposure. The odds of being HIV positive were increased in individuals who were in a relationship with an index case with a viral load of 400-3499 copies/mL (aOR 4.06 [95% CI 0.45-36.46]), 3,500-9,999 copies/mL (aOR 11.32 [95% CI: 4.08-31.39]), 10,000-49,999 copies/mL (aOR 17.07 [95% CI: 9.18-31.72]), and ≥50,000 copies/mL (aOR 28.41 [95% CI: 12.18-66.28]) compared to individuals who were in a relationship with an index case with a viral load of <400 copies/mL.
conclusionsLD remains a challenge in Southern Africa and is strongly associated with presumed HIV transmission to household sexual partners. Our study underscores the need for earlier HIV diagnosis, particularly among men and older adults, and the importance of index testing.
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