{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,18]],"date-time":"2026-08-18T04:27:53Z","timestamp":1787027273996,"version":"build-2736575974"},"reference-count":52,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2026,6,11]],"date-time":"2026-06-11T00:00:00Z","timestamp":1781136000000},"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>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Despite the Kingdom of Eswatini surpassing the UNAIDS 95\u201395-95 targets, the persistence of Advanced HIV Disease (AHD) remains a clinical concern. Advanced HIV Disease increases morbidity and mortality. This study evaluated the rate of AHD among newly diagnosed clients aged \u226515 identified through the community-based testing in comparison to the facility-based testing.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>\n                      A cross-sectional study was conducted in two groups (community and facility) of individuals newly diagnosed with HIV using secondary program data (October 2022\u2013September 2025) to identify clients with WHO clinical stages 3 and 4 or defining disease which represent advanced HIV disease with severe immunosuppression or with a CD4 count &amp;lt;200 cells\/mm\n                      <jats:sup>3<\/jats:sup>\n                      . Descriptive and comparative analyses were performed to compare AHD rates between the community and facility group. Bivariate and multivariable logistic regression analyses were utilized to identify associated factors of AHD for each group using STATA 19.5.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      The AHD rate was 19.0% (\n                      <jats:italic>n<\/jats:italic>\n                      \u202f=\u202f1,248) in the facility group and 16.7% (\n                      <jats:italic>n<\/jats:italic>\n                      \u202f=\u202f88) in the community group, with no statistically significant difference observed between the two groups (\n                      <jats:italic>p<\/jats:italic>\n                      \u202f&amp;gt;\u202f0.05). In facility group, factors associated with AHD included increase in age (aOR: 1.03 [1.01\u20131.05];\n                      <jats:italic>p<\/jats:italic>\n                      \u202f&amp;lt;\u202f0.001), male sex (aOR: 1.8 [1.5\u20132.1];\n                      <jats:italic>p<\/jats:italic>\n                      \u202f&amp;lt;\u202f0.001), and residing in Manzini (aOR: 1.6 [1.3\u20131.8];\n                      <jats:italic>p<\/jats:italic>\n                      \u202f&amp;lt;\u202f0.001). Conversely, age and sex were not significantly (\n                      <jats:italic>p<\/jats:italic>\n                      \u202f&amp;gt;\u202f0.05) associated with AHD in community-based testing setting. Delayed ART initiation (8\u201328\u202fdays) was associated with AHD in both groups, that is, community group (aOR: 3.2 [1.9\u20134.1];\n                      <jats:italic>p<\/jats:italic>\n                      \u202f=\u202f0.2) and facility group (aOR: 2.7 [2.1\u20133.3];\n                      <jats:italic>p<\/jats:italic>\n                      \u202f&amp;lt;\u202f0.001), reflecting the clinical complexity of stabilizing AHD prior to ART initiation.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>Community testing did not demonstrate an advantage in early diagnosis of HIV in this study, but reached a younger, mobile population than facility testing. Hence community testing can be a complementary strategy for sub populations who often bypass facility-based care as well as used in addressing localized drivers of late presentation. Facility-based testing, meanwhile, remains essential for symptomatic late presenters and people returning to care.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.3389\/fpubh.2026.1816639","type":"journal-article","created":{"date-parts":[[2026,6,11]],"date-time":"2026-06-11T05:48:32Z","timestamp":1781156912000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":1,"title":["Advanced HIV disease among newly diagnosed clients identified through community- and facility-based HIV testing services in Eswatini: a cross-sectional study"],"prefix":"10.3389","volume":"14","author":[{"given":"Samson","family":"Haumba","sequence":"first","affiliation":[{"name":"Center for Global Health Practice and Impact, Georgetown University","place":["Mbabane, Eswatini"]},{"name":"Center for Global Health Practice and Impact, Georgetown University","place":["Washington, DC, United States"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Thokozani","family":"Maseko","sequence":"additional","affiliation":[{"name":"Center for Global Health Practice and Impact, Georgetown University","place":["Mbabane, Eswatini"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Fezokuhle","family":"Khumalo","sequence":"additional","affiliation":[{"name":"Center for Global Health Practice and Impact, Georgetown University","place":["Mbabane, Eswatini"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nakekelo","family":"Mndzebele","sequence":"additional","affiliation":[{"name":"Center for Global Health Practice and Impact, Georgetown University","place":["Mbabane, Eswatini"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Makhosazana","family":"Dlamini","sequence":"additional","affiliation":[{"name":"Center for Global Health Practice and Impact, Georgetown University","place":["Mbabane, Eswatini"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sylvia","family":"Ojoo","sequence":"additional","affiliation":[{"name":"Center for Global Health Practice and Impact, Georgetown University","place":["Washington, DC, United States"]}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1965","published-online":{"date-parts":[[2026,6,11]]},"reference":[{"key":"ref1","volume-title":"WHO Guidelines on the Management of Advanced HIV Disease","year":"2025"},{"key":"ref2","doi-asserted-by":"publisher","first-page":"e26415","DOI":"10.1002\/jia2.26415","article-title":"Global prevalence of advanced HIV disease in healthcare settings: a rapid review","volume":"28","author":"Ford","year":"2025","journal-title":"J Int AIDS Soc"},{"key":"ref3","doi-asserted-by":"publisher","first-page":"S106","DOI":"10.1093\/cid\/cix1139","article-title":"Managing advanced HIV disease in a public health approach","volume":"66","author":"Ford","year":"2018","journal-title":"Clin 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