{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,6]],"date-time":"2026-07-06T22:30:25Z","timestamp":1783377025804,"version":"3.54.6"},"reference-count":31,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2024,1,15]],"date-time":"2024-01-15T00:00:00Z","timestamp":1705276800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Public Health"],"abstract":"<jats:sec><jats:title>Background<\/jats:title><jats:p>The impact of the \u201cTreat all\u201d policy on the individual and in terms of public health is closely related to early diagnosis and retention in care. Patient-level data are scarce in Madagascar. In this study, we aimed to describe the profile of a cohort of newly diagnosed people living with HIV\/AIDS (PLHIV), identify their outcomes, and assess factors associated with attrition from care and advanced HIV disease (AHD) at presentation.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>We conducted a retrospective cohort study of PLHIV aged \u226515 years newly diagnosed at the University Hospital Joseph Raseta Befelatanana Antananarivo from 1 January 2010 to 31 December 2016.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>A total of 490 PLHIV were included in the cohort analysis. In total, 67.1% were male. The median age (interquartile range) at enrollment in care was 29 years (24-38). Overall, 36.1% of PLHIV were diagnosed with AHD at baseline. The proportion of patients with WHO stage IV at baseline increased significantly from 3.3% in 2010 to 31% in 2016 (<jats:italic>p<\/jats:italic> = 0.001 for trend). The probability of retention in care after the diagnosis at 12 months, 24 months, and 36 months was 71.8%, 65.5%, and 61.3%, respectively. Age \u2265 40 years (aHR: 1.55; 95% CI: 1.05\u20132.29; <jats:italic>p<\/jats:italic> = 0.026), low level of education (aHR:1.62; 95% CI: 1.11\u20132.36; <jats:italic>p<\/jats:italic> = 0,013), unspecified level of education (aHR:2.18; 95% CI: 1.37\u20133.47; <jats:italic>p<\/jats:italic> = 0.001) and unemployment (aHR:1.52; 95% CI: 1.07\u20132.16; <jats:italic>p<\/jats:italic> = 0.019) were independently associated with attrition from care. Factors associated with AHD at baseline were age \u2265 40 (aOR: 2.77; 95% CI: 1.38\u20135.57, <jats:italic>p<\/jats:italic> = 0.004), unspecified level of education (aOR: 3.80; 95% CI: 1.58\u20139.16, <jats:italic>p<\/jats:italic> = 0.003) and presence of clinical symptoms at baseline (aOR: 23.81; 95% CI: 10.7\u201352.98; <jats:italic>p<\/jats:italic> &amp;lt; 0.001). Sex workers were independently less likely to have an AHD at presentation (aOR: 0.23; 95% CI: 0.05\u20130.96, <jats:italic>p<\/jats:italic> = 0.044).<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusion<\/jats:title><jats:p>Sociodemographic determinants influenced retention in care more than clinical factors. The presence of clinical symptoms and sociodemographic determinants were the main factors associated with AHD at baseline.<\/jats:p><\/jats:sec>","DOI":"10.3389\/fpubh.2023.1329194","type":"journal-article","created":{"date-parts":[[2024,1,15]],"date-time":"2024-01-15T04:17:10Z","timestamp":1705292230000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":3,"title":["A retrospective cohort analysis of people living with HIV\/AIDS enrolled in HIV care at a reference center in Antananarivo, Madagascar"],"prefix":"10.3389","volume":"11","author":[{"given":"Mihaja","family":"Raberahona","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Rado","family":"Rakotomalala","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Volatiana","family":"Andriananja","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Johary","family":"Andriamamonjisoa","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Etienne","family":"Rakotomijoro","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Radonirina Lazasoa","family":"Andrianasolo","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Rivonirina 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