Client risk segmentation to identify and respond to the differentiating characteristics of clients with advanced HIV disease in Kyrgyzstan: A retrospective analysis of routine program data

The World Health Organization recommends a comprehensive package of interventions to screen for, prevent, and treat advanced human immunodeficiency virus (HIV) disease (AHD). However, implementation remains suboptimal, particularly among key populations. We conducted a retrospective analysis of routine clinical data from HIV treatment sites supported by the PEPFAR-funded USAID Meeting Targets and Maintaining Epidemic Control (EpiC) Kyrgyzstan project. The analysis included baseline demographic and clinical characteristics of newly diagnosed adult persons living with HIV who initiated antiretroviral therapy between September 1, 2020 and December 31, 2021, at EpiC-supported sites. AHD was defined as a CD4 cell count <200 cells/mm or meeting the World Health Organization criteria for stage 3 or 4 disease. We used bivariate and multivariable logistic regression models to examine associations between client characteristics and AHD. Among 240 clients, 79 (32.9%) presented with AHD. In bivariate analysis, AHD was significantly associated with age ≥ 30 years (OR = 4.15; CI = 1.93-8.92); being widowed or divorced (OR = 3.21; CI = 1.78-5.78); or being a person who injects drugs, a sexual partner of persons living with HIV or client of female sex workers (OR = 4.44; CI = 2.13-9.25). In multivariable analysis, all except age remained significant predictors. Routine program data can help identify high-risk groups for AHD. Segmentation based on client characteristics may inform strategies to promote earlier HIV testing and tailored interventions for prevention and care.