Mémoire, y compris stage professionnalisant[BR]- Séminaires méthodologiques intégratifs[BR]- Mémoire : Risk factors of HIV late presentation and perceived barriers to early diagnosis in a single Belgian reference centre : a mixed method research

Abstract

Introduction : In 2020, Belgium had a rate of 6.3 new HIV diagnoses per 100,000 habitants. While this rate has been declining since 2012, the sharpest decline happened in 2020, which could be explained by the COVID-19 pandemic. Among the new diagnoses in 2020, 36% of them were late. Furthermore, being diagnosed late means entering care at a more advanced stage of the infection. Late presentation for care is linked with increased mortality and morbidity, increased costs of medical care, as well as increased sexual and vertical transmission of the virus due to a delayed start of treatment. Hence, the aim of this study is to continue a previous study in order to assess the risk factors of late presentation (with and without advanced HIV disease) in Belgium and to understand the perceived barriers to early diagnosis by late presenters, as well as the impact the COVID-19 pandemic had in the timeline of their diagnosis. Methods : A mixed method research was conducted. The risk factors of late presentation were assessed using a retrospective cohort study and perceived barriers to early diagnosis were appraised using phenomenology. In the quantitative part, data was collected from the Liège University Hospital’s database. In the qualitative part, data was collected during individual semi-structured interviews among 8 late presenters. Continuous thematic analysis was used to identify themes. Results : The risk of late presentation with advanced HIV disease increases with the patient’s age and for patients of Sub-Saharan African origin. Three barriers to early diagnosis were identified : the lack of knowledge about HIV, the general health perception and the perceived consequences of a positive test result. The COVID-19 pandemic may have had a role in late diagnoses as it caused missed opportunities and an uptake in risk behaviours. Conclusion : The results of this study suggest information campaigns to inform of risk behaviours, testing sites, treatment possibilities, medical care and possible symptoms of infection. It is also important to address the social stigma around HIV.