Health-seeking behaviours and their impact on HIV diagnostic outcomes: Implications for targeted HIV case-finding in Isolo, Lagos, Nigeria

Abstract

Introduction: Nigeria bears a significant HIV burden, ranking second globally in new infections. Late diagnosis remains a critical challenge, with many individuals identified only after disease progression, suggesting reliance on symptom-driven testing rather than proactive screening. Methods: This was a cross-sectional study conducted among 400 antiretroviral therapy (ART) patients at Isolo General Hospital, Lagos, between May and July 2025. A validated semi-structured questionnaire (Content Validity Index = 0.92) was used to collect data on pre-diagnosis symptoms, healthcare consultations, and HIV diagnosis pathways. Descriptive statistics and chi-square (Fisher’s exact) tests were used to examine the association between facility of consultation and facility of HIV diagnosis. Results: Among the 400 participants, 66.3% were female, with a mean age of 42.8 years. Before diagnosis, 65.8% reported symptoms, primarily weight loss (78.7%), fever (63.8%), and fatigue (51.7%), while 34.3% were asymptomatic. Government hospitals (62.8%) and private hospitals (34.3%) were the main consultation and diagnosis sites. Among single-facility users (n=193), a statistically significant association was found between facility of consultation and facility of HIV diagnosis (Fisher’s exact test; χ²=28.63, p<0.001), with concordance rates exceeding 96% for government and private hospitals. Community pharmacies showed a low concordance rate of 50%. Cramer’s V indicated a medium to large effect size (V=0.39). No participants relied solely on traditional healers. Conclusion: The findings highlight a symptom-driven diagnosis pattern in urban Lagos, with formal healthcare facilities as key entry points for HIV diagnosis. Proactive strategies such as index testing appear effective for identifying asymptomatic individuals, supporting the UNAIDS 95-95-95 goals.