{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,25]],"date-time":"2026-09-25T02:00:28Z","timestamp":1790301628199,"version":"4.1.0"},"reference-count":52,"publisher":"Wiley","license":[{"start":{"date-parts":[[2026,9,24]],"date-time":"2026-09-24T00:00:00Z","timestamp":1790208000000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"},{"start":{"date-parts":[[2026,9,24]],"date-time":"2026-09-24T00:00:00Z","timestamp":1790208000000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["HIV Medicine"],"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Objectives<\/jats:title>\n                    <jats:p>Late HIV diagnosis is associated with increased morbidity, mortality and onward transmission. The proportion diagnosed late reflects the combined effects of testing delays, incidence and migration, complicating its interpretation. We analysed national HIV surveillance data for Ireland (2015\u20132024) to understand the factors associated with late HIV diagnosis and testing delays.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>We estimated prevalence ratios (PRs) for late diagnosis among new diagnoses using Bayesian logistic regression with marginal standardization. We investigated testing delays by estimating infection times and modelling truncation\u2010adjusted delay distributions with Bayesian lognormal regression. We conducted several sensitivity analyses for the main findings.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Among 1551 included new HIV diagnoses with available information, 684 (44.1%) were late. This proportion exceeded 50% in several subgroups, including people aged over 50\u2009years, people whose probable mode of transmission was heterosexual contact, and people born in sub\u2010Saharan Africa. Increasing age (adjusted PR per decade 1.20; 95% credible interval [CrI] 1.15\u20131.26) and heterosexual transmission (adjusted PR for heterosexual men vs. sex between men 1.43; 95% CrI 1.23\u20131.67) were associated with late diagnosis in both univariable and multivariable models. For in\u2010Ireland infections, median time from infection to diagnosis was estimated at 1.94\u2009years (95% CrI 1.36\u20133.40), though this was particularly sensitive to modelling assumptions assessed in our sensitivity analyses, and the multivariable findings suggested longer time to diagnosis for men with heterosexual transmission in particular. For pre\u2010migration infections, median time from arrival to diagnosis was estimated at 0.60\u2009years (95% CrI 0.47\u20130.83), and an estimated 50.5% of those diagnosed to date were late.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>Late HIV diagnosis represents a significant challenge. Estimating time\u2010to\u2010diagnosis distributions may help separate the influence of testing delays from incidence and migration. The burden demonstrated across multiple groups highlights the need for normalization and expansion of HIV testing within and beyond traditional risk groups.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1111\/hiv.70311","type":"journal-article","created":{"date-parts":[[2026,9,25]],"date-time":"2026-09-25T01:45:12Z","timestamp":1790300712000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Late\n                    <scp>HIV<\/scp>\n                    diagnosis: An application of flexible Bayesian approaches to understand associated factors and time to diagnosis in Ireland, 2015\u20132024"],"prefix":"10.1111","author":[{"ORCID":"https:\/\/orcid.org\/0009-0004-2748-2406","authenticated-orcid":false,"given":"Cian","family":"Dowling\u2010Cullen","sequence":"first","affiliation":[{"name":"HSE National Health Protection Office, Health Protection Surveillance Centre  Dublin 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Ireland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3429-0611","authenticated-orcid":false,"given":"David","family":"Field","sequence":"additional","affiliation":[{"name":"Gay Men's Health Service  Dublin Ireland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Caroline","family":"Hurley","sequence":"additional","affiliation":[{"name":"HSE Sexual Health Programme  Dublin Ireland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Fiona","family":"Lyons","sequence":"additional","affiliation":[{"name":"HSE Sexual Health Programme  Dublin Ireland"},{"name":"School of Medicine Trinity College Dublin  Dublin Ireland"},{"name":"Department of Genitourinary Medicine and Infectious Diseases St James's Hospital  Dublin Ireland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Eavan","family":"Muldoon","sequence":"additional","affiliation":[{"name":"HSE National Clinical Programme for Infectious Diseases  Dublin Ireland"},{"name":"School of Medicine University College Dublin  Dublin Ireland"},{"name":"Department of Infectious Diseases Mater Misericordiae University Hospital  Dublin Ireland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9637-9603","authenticated-orcid":false,"given":"Peter","family":"Barrett","sequence":"additional","affiliation":[{"name":"School of Public Health University College Cork  Cork Ireland"},{"name":"Department of Public Health HSE South West  Cork Ireland"},{"name":"INFANT Research Centre, University College Cork  Cork Ireland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6599-9562","authenticated-orcid":false,"given":"Cathal","family":"Walsh","sequence":"additional","affiliation":[{"name":"Health Protection Surveillance Centre  Dublin Ireland"},{"name":"School of Medicine Trinity College Dublin  Dublin 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