Prevalence, predictors, and management of advanced HIV disease among individuals initiating ART in Senegal, West Africa
BMC Infectious Diseases·
- DOI
- 10.1186/s12879-019-3826-5
- PMID
- 30876400
- PMCID
- PMC6420737
- OpenAlex
- W2922006137
- Study type
- Guideline
- Publisher
- Springer Science and Business Media LLC
- Article type
- journal-article
- Integrity
- current
Why this research matters now
The high prevalence of advanced HIV disease at ART initiation and numerous missed opportunities for prevention and early diagnosis suggest substantial gaps in implementing WHO guidelines, indicating potential for preventable HIV-associated morbidity and mortality in Senegal.
Structured evidence summary
Research question
The study examined the prevalence of advanced HIV disease among individuals starting antiretroviral therapy in Senegal, identified factors associated with advanced disease at presentation, and assessed adherence to WHO management guidelines for advanced HIV.
Study design
Cross-sectional observational study conducted at ART initiation sites in Dakar and Ziguinchor, Senegal. Data collection included clinical evaluations, laboratory tests, questionnaires, and chart review; logistic regression identified predictors of advanced disease.
Population and setting
198 HIV-positive individuals initiating ART in Dakar and Ziguinchor, Senegal; 70% were female, with a median CD4 count of 185 cells/mm³.
Main findings
71% of participants had advanced HIV disease (CD4 count below 200 cells/mm³ or WHO stage 3 or 4). Age 35 years or older and seeking care from a traditional healer before HIV diagnosis were the strongest predictors of advanced disease. Implementation of WHO management guidelines was incomplete: only 65% of eligible individuals received co-trimoxazole prophylaxis, 39% of those with TB symptoms underwent diagnostic evaluation, one eligible person received isoniazid preventive therapy, and no participants received cryptococcal antigen screening or fluconazole pre-emptive therapy.
Public-health relevance
The high prevalence of advanced HIV disease at ART initiation and numerous missed opportunities for prevention and early diagnosis suggest substantial gaps in implementing WHO guidelines, indicating potential for preventable HIV-associated morbidity and mortality in Senegal.
Important limitations
This summary is limited to the supplied single-article abstract and metadata. Complete assessment of study limitations, including sampling methods, generalizability beyond the two study sites, potential selection bias, and measurement validity, requires review of the full published paper.
GIDS interpretation
This paper is indexed under AIDS, Tuberculosis (diseases), Senegal (country), and Diagnostics, Health policy, Treatment (topics), making it discoverable for queries related to HIV care gaps, TB-HIV co-management, and guideline implementation in West African settings.
Related GIDS surveillance
Literature context does not validate, explain, or change a surveillance signal. Exact and contextual relationships are shown separately.
Evidence relationships
This article has 13 auditable classifier relationships to diseases, places, topics, and study design.