Prevalence and factors associated with Advanced Disease among People Living with HIV in Masaka Region, Uganda

Abstract Background: A large percentage (22%) of people living with HIV (PLHIV) present for care with advanced HIV disease (AHD), threatening the achievement of the 95-95-95 goals to end AIDS by 2030. For anyone over the age of five, AHD is defined as CD4 count <200 cells/mm3 or with a current WHO stage 3 or 4 events. This study aimed to examine the prevalence and factors related to AHD among newly diagnosed PLHIV in Masaka Region, Uganda. Methods : We analyzed routinely collected electronic medical record data for newly diagnosed PLHIV who enrolled in HIV care across health facilities in 12 districts of the Masaka Region between October 2021 and September 2022. We assessed the proportion of participants with AHD and examined its association with sociodemographic and health-service characteristics, including age, sex, marital status, facility location, and point of entry into HIV care. Modified Poisson regression was used to estimate adjusted prevalence ratios (aPRs) and corresponding 95% confidence intervals (CIs) for factors associated with AHD. Results : Of 3,452 newly diagnosed PLHIV on ART included in this study, 2,254 (65.3%) were females. The prevalence of AHD was 15% (518). The results from multivariable modified Poisson regression revealed that participants aged 18-35 years had lower risk of AHD compared to those aged 5-17 years (aPR=0.45; 95% CI: 0.27, 0.78). Married individuals were at lower risk of AHD compared to unmarried participants (aPR=0.67; 95% CI: 0.57, 0.79). Male participants (269/1,198, 22.5%) had higher risk of AHD compared to females (249/2,254, 11.1%; aPR=1.85; 95% CI: 1.57, 2.19). Participants receiving ART services from urban facilities had higher risk of AHD compared to participants receiving ART from rural sites (aPR=1.61; 95% CI: 1.35, 1.93). Participants who were enrolled into care through HIV testing service outreaches (aPR=0.72; 95% CI: 0.58, 0.90) had lower risk of AHD while participants from other care points (aPR=1.28; 95% CI: 1.06, 1.53) had higher risk of AHD compared to the general outpatient point. Conclusions : The proportion of AHD in this cohort (15%) was lower than the national proportion of 22%. However, this work can be used to design interventions to address higher AHD prevalence among males, in urban facilities, and at care points other than HIV testing outreach sites and the general outpatient point.