Health-System and Access Determinants of Delayed HIV Diagnosis in Underserved, Remote, and Border Areas: A Rapid Review with Neuropsychiatric Relevance
DOI:
https://doi.cibangsa.org/DOI-2026-108Keywords:
HIV testing, access barriers, health-system determinants, underserved and remote settings, neuropsychiatric presentationsAbstract
Delayed HIV diagnosis and missed opportunities for earlier testing reflect not only patient-level and clinical factors but also the capacity of the health system to recognise an indicator condition, provide accessible testing, and sustain referral pathways, particularly in underserved, remote, and border settings and among patients with neuropsychiatric presentations. This rapid systematic review synthesises evidence on health-system and access-related determinants of delayed or missed HIV diagnosis in underserved, remote, rural, and border settings, and examines their relevance to patients presenting with neuropsychiatric manifestations. A structured search of PubMed/ MEDLINE , supplemented by additional scholarly searching, was conducted for publications from 2021 -2026, combining terms for HIV testing with health-system barriers, access barriers, rural or remote settings, and indicator-condition-guided testing, with dedicated terms for Indonesia and the Pacific; this single-reviewer, rapid-review search did not include independent dual screening or formal quality appraisal, and findings were synthesised narratively without meta-analysis. Eleven sources met the review's scope. Geographic distance, rural residence, provider-level testing gaps, indicator-condition-guided testing failures, and stigma were consistently identified as barriers across diverse settings, including Papua New Guinea, while two qualitative studies from a remote Indonesian border district identified transport cost, distance, and confidentiality concerns as barriers to HIV testing and sustained care; no evidence specific to Kabupaten Pegunungan Bintang, Papua, was identified. Health-system and access barriers to HIV testing are well documented internationally, but evidence specific to Kabupaten Pegunungan Bintang remains unavailable, providing a hypothesis-generating basis for local empirical investigation of these determinants in relation to clinical presentations, including neuropsychiatric presentations.References
Bogers, S. J., van der Loeff, M. F. S., Boyd, A., Prins, M., van Bergen, J., Geerlings, S. E., et al. (2021). Current evidence on the adoption of indicator condition guided testing for HIV in western countries: A systematic review and meta-analysis. EClinicalMedicine, 35, 100877.
Clausen, A., Stephenson, R. B., Sullivan, P. S., Edwards, O. W., Merrill, L., Acero Martinez, C., et al. (2023). Distance as a barrier to HIV testing among sexual and gender minority populations in the rural southern US: A cross-sectional study. Rural and Remote Health, 23, 8227.
Fauk, N. K., Sukmawati, A. S., Berek, P. A. L., Ernawati, Kristanti, E., Wardojo, S. S. I., et al. (2018). Barriers to HIV testing among male clients of female sex workers in Indonesia. International Journal for Equity in Health, 17, 68.
Fauk, N. K., Gesesew, H. A., Seran, A. L., & Ward, P. R. (2023). Barriers to access to antiretroviral therapy by people living with HIV in an Indonesian remote district during the COVID-19 pandemic: A qualitative study. BMC Infectious Diseases, 23, 296.
Gesesew, H. A., Gebremedhin, A. T., Demissie, T. D., Kerie, M. W., Sudhakar, M., & Mwanri, L. (2017). Significant association between perceived HIV related stigma and late presentation for HIV/AIDS care in low and middle-income countries: A systematic review and meta-analysis. PLoS One, 12(3), e0173928.
Jordans, C. C. E., Vasylyev, M., Rae, C., Jakobsen, M. L., Vassilenko, A., Dauby, N., et al. (2022). National medical specialty guidelines of HIV indicator conditions in Europe lack adequate HIV testing recommendations: A systematic guideline review. Eurosurveillance, 27(48), 2200338.
Mahmoud, M., Ballouz, T., Lahoud, C., Adnan, J., Habib, P. A., Saab, R., et al. (2024). Late presentations and missed opportunities among newly diagnosed HIV patients presenting to a specialty clinic in Lebanon. Scientific Reports, 14, 8296.
Maviso, M. (2024). Prevalence and predictors of HIV testing among young men in Papua New Guinea: A cross-sectional analysis of a nationally representative sample. PLoS One, 19(8), e0306807.
Pellowski, J. A. (2013). Barriers to care for rural people living with HIV: A review of domestic research and health care models. Journal of the Association of Nurses in AIDS Care, 24(5), 422-437.
Sun, C., Li, J., Liu, X., Zhang, Z., Qiu, T., Hu, H., et al. (2021). HIV/AIDS late presentation and its associated factors in China from 2010 to 2020: A systematic review and meta-analysis. AIDS Research and Therapy, 18, 96.
White, B. L., Walsh, J., Rayasam, S., Pathman, D. E., Adimora, A. A., & Golin, C. E. (2014). What makes me screen for HIV? Perceived barriers and facilitators to conducting recommended routine HIV testing among primary care physicians in the Southeastern United States. Journal of the International Association of Providers of AIDS Care, 14(2), 127-135.
