Late diagnosis of human immunodeficiency virus (HIV) and its associated factors in Asian countries: A systematic review.

Background: Despite widespread public health interventions and research on Human Immunodeficiency Virus (HIV), late diagnosis and presentation into care constitute serious challenges to effective prevention and control of the disease. Asia, the continent with the highest human population, accommodates a significant population of people living with HIV (PLWH), highlighting the need for effective prevention and control strategies.

Objectives: This review aims to systematically analyze the prevalence and the trend of late HIV diagnosis, and the associated risk factors in the Asian region.

Method: Following a literature search in Scopus, Science Direct, PubMed, and Google Scholar, the modified version of the PRISMA guidelines was applied in synthesizing results from relevant studies without performing meta-analyses.

Results: Twenty-one studies were included in the final analysis. The pooled prevalence estimates of late HIV presentation in China and Iran were 64.5% (95% CI: 42.6%-79.4%) and 68.2% (95% CI: 54.8%-85.6%) respectively, whereas the estimates from other Asian countries ranged from 28.5% to 71% (95% CI: 68.0%-73.0%). Most countries recorded a prevalence higher than 50%. The predominant risk factors were older age, being single, male gender, drug use, low educational status, and suffering from one or more comorbidities. Evidence suggests that changes in national guidelines and testing policies have contributed to the trend of HIV diagnosis in the Asian region.

Conclusion: Targeted public health interventions to enhance early HIV diagnosis and entry into care are urgently needed and should be tailored to target the high-risk groups in each country.