Prevalence and factors associated with Advanced Disease among People Living with HIV in Masaka Region, Uganda

HIV is a virus that attacks the body's immune system, the internal defense network that fights off infections and illnesses. When a person lives with HIV, the virus slowly weakens this system over time. If the infection is not treated with medication, the immune system can become so damaged that it can no longer protect the body from common germs. This critical stage is known as advanced HIV disease. In medical terms, doctors identify this condition by counting specific immune cells called CD4 cells; when the count drops below a certain threshold, or when a person develops severe illnesses that a healthy immune system would easily handle, they are considered to have advanced disease. Catching HIV early and starting treatment immediately is the most effective way to prevent this decline, yet many people still reach this dangerous stage before they even know they are infected. Understanding who is most likely to arrive at this point and why is essential for saving lives and stopping the spread of the virus.

In the Masaka region of Uganda, researchers set out to understand the current reality of this problem. They examined the medical records of thousands of people who had just been diagnosed with HIV and were beginning their care journey. The team looked at data collected between October 2021 and September 2022 from health facilities across twelve districts. Their goal was to measure how many of these newly diagnosed individuals were already suffering from advanced disease and to identify the specific factors that made this outcome more likely. By analyzing routine records from over three thousand patients, the researchers could see clear patterns in how age, gender, location, and how a person found their way to a clinic influenced their health status at the moment of diagnosis.

The study revealed that fifteen percent of the newly diagnosed people in this region were already living with advanced HIV disease. While this figure is lower than the national average for Uganda, it represents a significant number of people who have been living with the virus for some time without knowing it, allowing the infection to severely weaken their immune systems. The researchers found that the risk of having advanced disease was not spread evenly across the population. Men were far more likely to be in this critical condition than women. Among the men who were newly diagnosed, more than one in five had advanced disease, whereas only about one in ten women faced the same severity. This gap suggests that men are waiting longer to seek help or are less likely to get tested until their health has already deteriorated.

Age also played a distinct role in the findings. The youngest group studied, children and teenagers between the ages of five and seventeen, faced the highest risk of advanced disease compared to adults. This group was significantly more likely to have a severely weakened immune system than those in the prime working years of eighteen to thirty-five. The data suggests that children and adolescents may be diagnosed later in the course of their infection, or they may face unique biological or access barriers that allow the virus to progress more rapidly before treatment begins. In contrast, being married was a protective factor; married individuals were less likely to have advanced disease than those who were single, widowed, or divorced, possibly because marriage encourages more consistent health-seeking behavior or earlier testing.

Where a person received their care and how they entered the healthcare system also mattered deeply. People who were diagnosed and started treatment at clinics in urban areas were more likely to have advanced disease than those in rural settings. Furthermore, the path a person took to find a doctor made a difference. Those who were reached by health workers going out into the community to test people were less likely to have advanced disease. This indicates that proactive outreach is effective at finding people while they are still healthy. Conversely, people who were identified through other, less specific channels, or who came to the clinic without a prior community contact, were more likely to arrive with severe illness.

The researchers concluded that while progress has been made, specific groups remain vulnerable. The findings point directly to the need for targeted efforts to reach men, children, and adolescents, as well as those in urban centers who are not being caught by community testing programs. By focusing on these high-risk groups and encouraging earlier testing, health officials can hope to reduce the number of people who arrive at the clinic with their immune systems already in crisis. The study provides a clear map of where the gaps exist, offering a practical guide for designing interventions that can save lives by ensuring people start treatment before the virus causes irreversible damage.