Factors associated with late presentation for HIV care and treatment progression among adults in rural South Africa

Chodziwadziwa Whiteson Kabudula, University of the Witwatersrand
Georges Reniers, London School of Hygiene and Tropical Medicine (LSHTM)
F. Xavier Gómez-Olivé, University of the Witwatersrand
Nkosinathi Masilela, University of the Witwatersrand
Kathleen Kahn, University of the Witwatersrand
Stephen Tollman, University of the Witwatersrand

Late presentation for treatment has been one of the major factors limiting the effectiveness of antiretroviral therapy in generalized epidemics. In this contribution we use a composite data source comprising data from the Agincourt Health and Demographic Surveillance System (HDSS) and data from the chronic care units of eight health facilities that residents of the Agincourt HDSS use. Record linkage between the two data sources is done at the health facility and in the presence of the patient, which ensures high quality matches and provides an opportunity to seek informed consent from the patient. We use these data to relate individual and household characteristics collected during routine demographic surveillance (household wealth, household composition, marital status, parenthood status, …) to (i) late presentation as measured by the CD4 cell count at first presentation, and (ii) the progression form first presentation to treatment initiation.