Late presentation of HIV positive adults and its predictors to HIV/AIDS care in Ethiopia: A systematic review and meta-analysis

INTRODUCTION: Late presentation to HIV/AIDS care which is attended by problems like, poor treatment outcomes, early development of opportunistic infections, increased healthcare costs, and mortality is a major problem in Ethiopia. Although evidences are available on the prevalence and associated factors of late presentation to HIV/AIDS care, discrepancies among findings are appreciated. Thus, the country has faced difficulties of having a single estimated data. OBJECTIVE: This study aimed to estimate the pooled prevalence of late presentation of HIV positive adults to HIV/AIDS care and its predictors in Ethiopia. METHOD: We searched all available articles through Google Scholar, PubMed, Web of Sciences, and EMBASE databases. Additionally, we accessed articles from the Ethiopian institutional online research repositories and reference lists of included studies. We included cohort, case- control, and cross-sectional studies in our review. Besides, we utilized the weighted inverse variance random-effects model. The total percentage of variation among studies due to heterogeneity was determined by I(2) statistic. Searching was limited to studies conducted in Ethiopia and published in the English language. Publication bias was checked by Egger’s regression test. RESULTS: A total of 8 studies with 7, 568 participants were included. The pooled prevalence of late presentation to HIV/AIDS care was 52.89% (95%CI: 35.37, 70.40). The odds of late presentation to HIV/AIDS care of frequent alcohol users [3.67(95% CI = 1.52-5.83)], high fear of stigma [3.90 (95% CI = 1.51-6.28)], chronic illness [3.34(95% CI = 1.52-5.16)], and the presence of symptoms at the time of HIV diagnosis [3.06 (95% CL = 1.18-4.94)] were higher compared to participants who did not experience the preceding. CONCLUSION: The prevalence of late presentation of HIV positive adults to HIV/AIDS care was high in Ethiopia. Frequent alcohol use, high fear of stigma, chronic illness, and the presence of symptoms at the time of HIV diagnosis were associated with high odds of late presentation to HIV/AIDS care. TRIAL REGISTRATION: Registered in PROSPERO databases with the registration number of CRD42018081840

• Epidemiology and Determinants of Health
  • Epidemiology
• Determinants of Health
  • Stigma/discrimination
• Population(s)
  • General HIV+ population
• Engagement and Care Cascade
  • Linkage/engagement in care
• Substance Use
  • Alcohol