Late HIV diagnosis in Georgia: public health and economic implications

N Chkhartishvili, L Sharvadze, P Gabunia, A Abutidze, M Nikolaishvili, T Tsertsvadze


Background: Late HIV diagnosis has major individual and population implications  in terms of patient survival, onward transmission  of HIV and higher health expenditures.  The objective  of this study was to evaluate  the problem of late diagnosis in Georgia, which since 2004 ensures universal to antiretroviral therapy (ART).

Methods: This was retrospective cohort study that included adult (age ≥18 years) HIV patients newly diagnosed during 2009-2011,  who received care at the national referral institution  for HIV diagnosis,  treatment  and care. Patient-level data  were  abstracted  from  medical  and  accounting  records.  Individuals  were  followed  until  death  or July  1, 2012 whichever occurred first. Mortality rates were calculated for total follow-up period as number of events divided by the number of total person-years (PY) of follow-up. Costs per person-year were calculated as total costs incurred divided by the total number of PY contributed.

Results: Study included 1,002 patients (81% of total diagnoses).  Among them the median age was 37 years and 71% were men. Majority was infected via either IDU (50%) or heterosexual  contact (44%). A total of 702 (70.1%) patients were classified as late presenters (defined as CD4 <350 and/or AIDS) and 512 (51.1%) patients presented with advanced disease (defined as CD4 <200 and/or AIDS). Patients were followed for a median 1.2 years and contributed 1,305 PY of follow-up. Overall 137 late presenters and 8 non-late presenters died (mortality rates: 16.1 per 100 PY vs. 1.8 per 100 PY, p<0.0001).  Among  patients  presenting  with advanced  disease  129 died compared  to 16 deaths  among  patients without advanced HIV diseases (mortality rates: 21.7 per 100 PY vs. 2.3 per 100 PY, p<0.0001). Total expenditures  per person-year  for  late  presenters  were  1,171  USD  vs.  579  USD  among  those  not  presenting  late  (p<0.0001).  Total expenditures  per person-year  among patients presenting with advanced disease amounted to 1,394 USD vs. 606 USD (p<0.0001).

Conclusions: The study provides evidence that late HIV diagnosis in Georgia negatively affects HIV epidemic both from public health and economic standpoints. Improving earlier diagnosis and supporting continued high engagement in the HIV care continuum will be critical for achieving success. 


HIV, AIDS, late diagnosis, mortality, health expenditures

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