Determinants of late HIV diagnosis among patients attending ART clinics in amhara region northwest Ethiopia

Late HIV diagnosis remains a major barrier to HIV/AIDS control globally. According to UNAIDS, about 8.6 million people living with HIV were diagnosed at advanced stages in early 2025, particularly in low-resource settings. Early diagnosis is vital for timely antiretroviral therapy and improved outcomes. In Ethiopia, despite national efforts to expand testing, late presentation to care persists. Limited and outdated evidence on determinants of late HIV diagnosis hinders targeted interventions. To identify determinants of late HIV diagnosis among HIV-positive patients attending ART clinics in the Amhara region, Northwest Ethiopia. An institution-based unmatched case-control study was conducted among 255 participants (127 cases and 128 controls) in West Gojjam Zone Hospitals from February to March 2025. Cases were individuals presenting with a CD4 count < 350 cells/µL or WHO stage III/IV, while controls had a CD4 count ≥ 350 cells/µL or WHO stage I/II. Participants were selected by simple random sampling. Data were collected through chart reviews and interviewer-administered questionnaires by trained nurses. Data entry was performed using EpiData version 4.3.6 and analyzed with SPSS version 25. Binary logistic regression was used to identify determinants of late diagnosis, with significance at p < 0.05 and 95% confidence intervals. Of the 255 recruited participants, 251 completed the study (125 cases and 126 controls), yielding a 98.4% response rate. Females accounted for 62.9% of respondents. HIV testing initiated by friends, family, or social contacts (AOR = 3.54; 95% CI: 1.34-9.36), provider-initiated testing and counseling (AOR = 3.49; 95% CI: 1.70-7.10), alcohol drinkers (AOR = 3.96; 95% CI: 2.13-7.38), individuals who had poor HIV knowledge (AOR = 3.24; 95% CI: 1.64-6.40), and perceived stigma (AOR = 4.82; 95% CI: 2.39-9.74) were statistically significant determinants of late HIV diagnosis. Late HIV diagnosis was strongly associated with non-voluntary testing, alcohol use, poor knowledge, and perceived stigma. Findings highlight the need for targeted interventions promoting voluntary testing, reducing stigma, and strengthening community awareness.