Multi-level Factors Associated with HIV Late Presentation with Advanced Disease and Delay Time of Diagnosis in South Carolina, 2005-2019

This study explored individual- and county-level risk factors of late presentation with advanced disease (LPAD) among people with HIV (PWH) and their longer delay time from infection to diagnosis in South Carolina (SC), using SC statewide Enhanced HIV/AIDS Reporting System (eHARS). LPAD was defined as having an AIDS diagnosis within three months of initial HIV diagnosis, and delay time from HIV infection to diagnosis was estimated using CD4 depletion model. 3,733 (41.88%) out of 8,913 adult PWH diagnosed from 2005 to 2019 in SC were LPAD, and the median delay time was 13.04 years. Based on the generalized estimating equations models, PWH who were male (adjusted prevalence ratio [aPR]: 1.22, 95% CI: 1.12 similar to 1.33), aged 55+ (aPR: 1.76, 95% CI: 1.62 similar to 1.92), were Black (aPR: 1.09, 95% CI: 1.03 similar to 1.15) or Hispanic (aPR: 1.42, 95% CI: 1.26 similar to 1.61), and living in counties with a larger proportion of unemployment individuals (aPR: 1.02, 95% CI: 1.01 similar to 1.03) were more likely to be LPAD. Among PWH who were LPAD, Hispanic (adjusted beta: 1.17, 95% CI: 0.49 similar to 1.85) instead of Black (adjusted beta: 0.11, 95% CI: -0.30 similar to 0.52) individuals had significant longer delay time compared to White individuals. Targeted and sustained interventions are needed for older, male, Hispanic or Black individuals and those living in counties with a higher percentage of unemployment because of their higher risk of LPAD. Additionally, specific attention should be paid to Hispanic individuals due to their longer delay time to diagnosis.