7 and 33.1% of French seropositive patients, respectively, still experienced delayed access to care, which was defined as a CD4 count <200 cells/μL or AIDS-stage disease at presentation. However, neither study addressed the delay between diagnosis and first consultation for primary care. Using data from the VESPA [Agence Nationale de Recherche sur le SIDA (ANRS)-EN12] study, we determined time to first consultation after HIV diagnosis, and identified factors associated with delayed entry to
care in the context of free access to diagnosis and care. The VESPA survey was conducted in out-patient hospitals . Our study population consisted of 2932 patients (from 4963 eligible patients). Percentages of patients waiting ≥6 months for their first post-diagnosis HIV consultation within three specific diagnosis periods were 30.6% for 1982–1989 (n=840), 11.9% for 1990–1996 (n=1132), CAL-101 price and 3.5% for 1997–2003 (n=945). Thanks Vemurafenib molecular weight to free and widespread care and antiretroviral therapy (ART) in France, in the most recent period considered, only a minority
of HIV-positive people still experienced long delays between diagnosis and their first HIV care consultation. Multivariate analysis helped to determine individual correlates of late entry into care after diagnosis for those diagnosed from 1997 onwards (n=945), a key year in terms of widespread availability of protease inhibitors. The model was estimated using rare events logistic Arachidonate 15-lipoxygenase regression , for which the relogit package in stata (StataCorp LP, College Station, TX, USA) was employed. Factors associated with reporting a delay of ≥6 months before first consultation were: HIV diagnosis in a foreign country [odds ratio (OR) 11.8; 95% confidence interval (CI) 4.9–28.9; P<0.001]; history of IDU (OR 5.2; 95% CI 2.1–12.6; P<0.001); being a heterosexual man (OR 3.4; 95% CI 1.2–9.7; P=0.02); having a seropositive partner (OR 3.1; 95% CI 1.2–8.5; P=0.02); and being younger at the time of diagnosis
(OR 0.92; 95% CI 0.87–0.97; P=0.001). These characteristics are similar to those for ‘late testers’ in the VESPA study , except for age (associated with late diagnosis only). No significant association was found in terms of diagnosis setting or whether diagnosis was at the patient’s or healthcare provider’s request. In the context of free access to effective HIV care in the ART era, late entry into medical care is mainly attributable to late initial diagnosis. These data confirm the need to improve HIV testing policies in France. Although the French health system provides a satisfactory linkage with care after HIV diagnosis, it does not overcome barriers to initial testing (i.e. patients, care providers, cultural and social beliefs and stigmatization).