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                <title xml:lang="en">Estimation of the duration between HIV seroconversion and HIV diagnosis in different population groups in French Guiana: Strategic information to reduce the proportion of undiagnosed infections</title>
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              <p>BACKGROUND:Given the great efforts put into the strategic objective of reducing the proportion of HIV-infected patients that are undiagnosed, the aim of the present study was to review the temporal trends between 1997 and 2016 for median estimates of infection duration and median CD4 count at diagnosis for the main patient origins in French Guiana.METHODS:CD4 cell count at HIV sero-conversion and square root of CD4 cell decline were obtained using the CD4 decline in a cohort of HIV-infected persons in the UK, fitting random effect (slope and intercept) multilevel linear regression models. Multivariate analysis used robust regression for modeling the delay between estimated HIV seroconversion and diagnosis and quantile regression for CD4 at HIV diagnosis.RESULTS:The median interval between the estimated HIV seroconversion and HIV diagnosis was 8 years for patients fromBrazil, 4.5 years for those from Haiti, 6.6 years for those from Suriname, 3.3 years for patients from Guyana, and 3.1 years for French patients. A simple robust regression model with French patients as reference group adjusting for sex and age at the time of diagnosis showed that the interval was significantly longer for Brazilian (β = +3.7 years, P = 0.001), Surinamese (β = +4.2 years, P&lt;0.0001), Haitian origins (β = +1.5 years, P = 0.049) but not for those originating from Guyana (β = -0.03 years, P = 0.9); Men independently had a longer interval than women (β = +3.5 years, P&lt;0.0001).CONCLUSIONS:Despite great efforts in French Guiana regarding HIV testing both in terms of diversification and intensification we still need to tailor the offer to better reach the communities in need. These results should help authorities scale up and optimize initiatives to reduce the proportion of patients who are unaware of their infection. They also raise the question of the role of stigma and discrimination as a barrier to HIV testing in small communities, and further emphasize the importance of reducing it</p>
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          <orgName>Hôpital de Jour Adultes [Cayenne, Guyane Française]</orgName>
          <desc>
            <address>
              <addrLine>Cayenne</addrLine>
              <country key="GF"/>
            </address>
          </desc>
          <listRelation>
            <relation active="#struct-494314" type="direct"/>
            <relation active="#struct-537699" type="direct"/>
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        </org>
        <org type="laboratory" xml:id="struct-193869" status="VALID">
          <orgName>Agence Régionale de Santé Guyane</orgName>
          <orgName type="acronym">ARS Guyane</orgName>
          <desc>
            <address>
              <addrLine>66 Avenue des flamboyants, 97306 Cayenne</addrLine>
              <country key="GF"/>
            </address>
            <ref type="url">https://www.guyane.ars.sante.fr/</ref>
          </desc>
          <listRelation>
            <relation active="#struct-326046" type="direct"/>
          </listRelation>
        </org>
        <org type="laboratory" xml:id="struct-542819" status="INCOMING">
          <orgName>Service de Dermatologie Vénéréologie [Cayenne, Guyane française]</orgName>
          <desc>
            <address>
              <addrLine>Cayenne</addrLine>
              <country key="GF"/>
            </address>
          </desc>
          <listRelation>
            <relation active="#struct-494314" type="direct"/>
          </listRelation>
        </org>
        <org type="institution" xml:id="struct-93016" status="OLD">
          <idno type="IdRef">026603136</idno>
          <idno type="ROR">https://ror.org/02ryfmr77</idno>
          <orgName>Université des Antilles et de la Guyane</orgName>
          <orgName type="acronym">UAG</orgName>
          <date type="start">1982-07-02</date>
          <date type="end">2015-06-24</date>
          <desc>
            <address>
              <addrLine>Fouillole - BP 250 - 97157 Pointe-à-Pitre</addrLine>
              <country key="GP"/>
            </address>
            <ref type="url">http://www.univ-ag.fr/</ref>
          </desc>
        </org>
        <org type="institution" xml:id="struct-303623" status="VALID">
          <idno type="IdRef">026388278</idno>
          <idno type="ROR">https://ror.org/02vjkv261</idno>
          <orgName>Institut National de la Santé et de la Recherche Médicale</orgName>
          <orgName type="acronym">INSERM</orgName>
          <desc>
            <address>
              <addrLine>101, rue de Tolbiac, 75013 Paris</addrLine>
              <country key="FR"/>
            </address>
            <ref type="url">http://www.inserm.fr</ref>
          </desc>
        </org>
        <org type="institution" xml:id="struct-328176" status="VALID">
          <idno type="ROR">https://ror.org/04sfmcd28</idno>
          <orgName>CHU Pointe-à-Pitre / Abymes [Guadeloupe]</orgName>
          <desc>
            <address>
              <addrLine>Route de Chauvel - BP 465 - 97159 Pointe-à-Pitre cedex</addrLine>
              <country key="FR"/>
            </address>
            <ref type="url">https://www.chu-guadeloupe.fr</ref>
          </desc>
        </org>
        <org type="institution" xml:id="struct-360574" status="INCOMING">
          <orgName>CHU de Fort de France</orgName>
          <desc>
            <address>
              <country key="FR"/>
            </address>
          </desc>
        </org>
        <org type="institution" xml:id="struct-494314" status="VALID">
          <orgName>Centre Hospitalier Andrée Rosemon [Cayenne, Guyane Française]</orgName>
          <desc>
            <address>
              <addrLine>Av des flamboyants, Cayenne 97306</addrLine>
              <country key="GF"/>
            </address>
            <ref type="url">http://www.ch-cayenne.fr/</ref>
          </desc>
        </org>
        <org type="institution" xml:id="struct-424370" status="VALID">
          <idno type="IdRef">188204024</idno>
          <idno type="ROR">https://ror.org/00nb39k71</idno>
          <orgName>Université de Guyane</orgName>
          <orgName type="acronym">UG</orgName>
          <desc>
            <address>
              <addrLine>Campus de Troubiran - BP 20792- 97337 Cayenne Cedex - Guyane</addrLine>
              <country key="GF"/>
            </address>
            <ref type="url">https://www.univ-guyane.fr</ref>
          </desc>
        </org>
        <org type="institution" xml:id="struct-537699" status="INCOMING">
          <orgName>Cayenne General Hospital</orgName>
          <desc>
            <address>
              <country key="FR"/>
            </address>
          </desc>
        </org>
        <org type="institution" xml:id="struct-326046" status="VALID">
          <orgName>Agence Régionale de la Santé</orgName>
          <orgName type="acronym">ARS</orgName>
          <desc>
            <address>
              <country key="FR"/>
            </address>
            <ref type="url">https://www.ars.sante.fr/</ref>
          </desc>
        </org>
      </listOrg>
    </back>
  </text>
</TEI>