Prevalence and Predictors of Late presentation to HIV/AIDS care in Uvira, South Kivu Province, Democratic Republic of the Congo

Abstract

Abstract Background Late presentation (LP) to HIV/AIDS care remains a major barrier to effective treatment outcomes and the reduction of HIV transmission, particularly in resource-limited settings. In the Democratic Republic of the Congo (DRC), despite national initiatives to expand HIV testing and antiretroviral therapy (ART) coverage, many people living with HIV (PLHIV) still enter care at advanced stages of disease progression. This study aimed to determine the prevalence and identify the predictors of LP to HIV/AIDS care in Uvira. Methods A cross-sectional study was conducted from August to October 2024 among PLHIV attending ART clinics in Uvira. A total of 275 participants were proportionally recruited from all 10 ART sites using consecutive sampling. Data were collected through structured interviews and clinical record reviews. LP was defined as WHO clinical stage III/IV or a CD4 count below 350 cells/mm³ at entry into care. Data analysis was performed using Epi Info and SPSS software. Bivariate and multivariate logistic regression analyses were conducted to identify independent predictors of LP, with significance set at p < 0.05. Results The prevalence of LP was 51.3%. Independent predictors of LP included alcohol intake (AOR = 2.01; 95% CI: 1.09–3.70), age above 24 years (AOR = 3.17; 95% CI: 1.13–8.93), monthly income ≥200 USD (AOR = 2.02; 95% CI: 1.06–3.85), no formal education (AOR = 3.09; 95% CI: 1.28–7.48), fear of disclosure (AOR = 5.23; 95% CI: 2.03–13.5), and non-use of condoms (AOR = 2.38; 95% CI: 1.07–5.31). Conclusion LP to HIV care remains highly prevalent in Uvira, highlighting persistent challenges in early diagnosis and linkage to care. Strengthening community awareness, expanding HIV testing, and addressing socioeconomic and behavioral barriers are crucial to enhancing early engagement in care and improving treatment outcomes across the DRC.