Decrease in late presentation for HIV care in Kinshasa, DRC, 2006-2020.

INTRODUCTION: Late presentation for HIV care is a well-described issue for the success of ART outcomes and the cause of higher morbidity, mortality and further transmission. Monitoring the level of late presentation and understanding the factors associated with it would help to tailor screening and information strategies for better efficiency. We performed a retrospective cohort study in Kinshasa, the capital of the DRC. The studied population included HIV-positive adults newly enrolled in HIV care between January 2006 and June 2020 at 25 HIV urban care facilities. Patient information collected at presentation for HIV care included age, sex, WHO clinical stage and screening context. We used 2 definitions of late presentation: the WHO definition of advanced HIV disease (WHO stage 3/4 or CD4 cell count < 200 cells/mm3) and a more inclusive definition (WHO stage 3/4 or CD4 cell count < 350 cells/mm3). RESULTS: A total of 10,137 HIV-infected individuals were included in the analysis. The median age was 40 years; 68% were female. A total of 45.9% or 47.5% of the patients were late presenters, depending on the definition used. The percentage of patients with late presentation (defined as WHO stage 3/4 or CD4 cell count < 350 cells/mm3) decreased during recent years, from 70.7% in 2013 to 46.5% in 2017 and 23.4% in 2020. Age was associated with a significantly higher risk of LP (p < 0.0001). We did not observe any impact of sex. CONCLUSIONS: The frequency of late presentation for care is decreasing in Kinshasa, DRC. Efforts have to be continued. In particular, the issue of late diagnosis in older individuals should be addressed.

Factors associated with acceptability of HIV self-testing (HIVST) among university students in a Peri-Urban area of the Democratic Republic of Congo (DRC).

INTRODUCTION: this paper examines the acceptability of HIV self-testing (HIVST) by students in a university in the DRC and identifies factors associated with uptake of HIVST. METHODS: a cross-sectional study was conducted with a sample of 290 students from Kikwit University. Data were summarized using proportions and predictions of acceptability of HIVST by logistic regression. RESULTS: the average age of students was 22.5 years, with the majority of the students being male (57%). Just over half the students sampled, reported being sexually active (51.8%). One hundred and sixty four (75%) reported that they had one sexual partner and fifty-six (25%) two or more sexual partners in the past year. Sixty-six percent had used condoms during their last sexual encounter. The acceptability of HIVST was high (81.4%) and 66.1% of students stated that they would confirm the self-test at a local health facility. The knowledge about the importance of the self-test (OR 5.02; 95% CI:1.33-18.88; p=0.017), the perception that counseling pre and post-test were important (OR 2.91; 95% CI:1.63-5.19; p < 0.0001) and the willingness to realize the test with a partner (OR 2.46; 95% CI:1.43-4.23; p=0.034) were factors associated with HIVST. CONCLUSION: the acceptability of HIVST was high and therefore its implementation is feasible in our country. However, prior to implementation, additional factors such as cost; access of HIVST; false reassurance of the test; missed early infections in the window period, limited counseling and linkage to care options, need to be considered.