Prevalence and factors associated with late presentation for HIV care among adult men at a large HIV clinic in Eastern Uganda: A cross-sectional study

Introduction: In Uganda, men diagnosed with HIV still present late for care. Understanding the drivers of late presentation among men is a critical step towards achieving the full potential of HIV treatment scale-up. This study aimed to determine the prevalence and factors associated with late presentation for HIV care among adult men in Jinja District, Eastern Uganda. Methods: We conducted a cross-sectional study in Jinja District from October to November 2020. We defined late presentation for HIV/AIDS care as persons presenting for care with a CD4 cell count below 350 cells/μl or presenting with an AIDS defining event, regardless of the CD4 cell count. We used semi-structured questionnaires to interview 394 HIV positive adult men receiving care at Family Hope Centre, and reviewed patient files to collect data on baseline CD4 cell count. We used modified Poisson regression analysis to determine factors associated with late presentation for HIV care. Results: The proportion of adult men who presented late for HIV care was 313/394 (79.4%), 95% CI: [0.754,0.834]. Men were less likely to present late for care if aged 25-34 years; [Adj. PR 0.13; 95%CI: 0.03-0.60], 35-49 years; [Adj. PR 0.47; 95%CI: 0.24-0.91] or had been supported by family; [Adj. PR 0.36; 95%CI: 0.18-0.73] compared to their counterparts. Conclusion: This study highlights a notably high rate of late HIV care presentation among men in the facility’s catchment area. To address this issue, a comprehensive approach is necessary. Key strategies should include developing services specifically designed for young adults and those without familial support, as these groups are more likely to experience delays. Incorporating family counseling into treatment programs can provide crucial support for newly diagnosed individuals. Encouraging open conversations about HIV status and reshaping perceptions of masculinity to promote health-seeking behaviors will also help reduce stigma. Future research should focus on cultural and behavioral factors influencing delayed care, particularly among younger men and those without family support, while evaluating the effectiveness of specialized services in improving outcomes.