Background: Despite significant advancements in the management of Human Immunodeficiency Virus (HIV), challenges persist in achieving early diagnosis, especially in contexts with sociocultural and structural barriers.

Aim: This study investigates factors associated with late presentation (LP) among people living with HIV (PLWH) in Oman from 1992 to 2024.

Methods: An ambidirectional cohort study was conducted at the Royal Hospital in Muscat, including adult HIV-positive patients aged ≥18 years with complete baseline data, specifically documented CD4 counts, viral load, and hemoglobin levels. Data extracted from hospital electronic records were analyzed using binary logistic regression, with significance set at p ≤ 0.05.

Results: Of the 549 patients studied, 30.1% presented late for treatment. Among late presenters, 72.1% were infected via sexual transmission, 64.8% were asymptomatic, and 52.5% had no comorbidities. Younger age groups had significantly higher adjusted relative risks (aRR) of late presentation: 5.66 (95% CI: 2.26–14.21) for ages 18–27, 3.25 (95% CI: 1.33–7.94) for ages 28–37, and 3.51 (95% CI: 1.40–8.77) for ages 38–47, compared to those aged ≥48 years. Notably, low hemoglobin levels (<10 g/dL) were associated with a decreased risk of late presentation (aRR = 0.33; 95% CI: 0.15–0.70). Patients who were asymptomatic or classified as stage 1 (aRR = 7.34; 95% CI: 3.12–14.29) and those with advanced symptoms or stage 3 disease (aRR = 2.93; 95% CI: 1.40–5.68) were more likely to present late compared to individuals with severe symptoms or stage 4 disease. Additionally, patients with heart disease (aRR = 5.38; 95% CI: 1.36–21.31) and hypertension (aRR = 3.34; 95% CI: 1.13–9.91) demonstrated increased likelihood of late presentation compared to those without comorbidities.

Conclusion: This study identifies key factors influencing the timing of HIV diagnosis in Oman from 1992 to 2024, providing critical evidence to support data-driven decision-making. Late presentation was more prevalent among younger patients, those with, in disease stages 1 and 3, and those with cardiovascular comorbidities. However, those with low hemoglobin presented early. These findings emphasize the urgent need for enhanced early testing strategies, tailored clinical care, stigma reduction, and timely psychosocial interventions to improve outcomes and support Oman’s 95-95-95 targets.

Zainab Mahmood Dilshad Al-Zadjali is an Infection Prevention and Control Specialist with more than a decade of experience in clinical practice and public health. She began her leadership career in 2009 as Head of the Infection Prevention and Control Program at the Directorate General of Health Services (DGHS) in Muscat Governorate, where she played a key role in advancing infection prevention programs. In 2019, she further contributed to program development at the Department of School and University Health within the Ministry of Health. She is currently a PhD candidate in Epidemiology and Public Health at Sultan Qaboos University. As a Research Associate and Co-Author, she has collaborated on several projects, including “Prevalence and Sociodemographic Correlates of HIV-Related Stigma Among People Living with HIV in Oman” and “Economic Burden of Vancomycin Use in Methicillin-Resistant Staphylococcus aureus Infections Among Intensive Care Unit Patients at Sultan Qaboos University Hospital (2019–2023),” both under publication. Ms. Al-Zadjali has also served as the main and submitting author of “Assessment of Patient Safety Culture Among Healthcare Professionals in Oman: A Cross-Sectional Study,” published in The Scientific World Journal/Wiley. Additionally, she contributed as a Research Assistant and Co-Author to “Direct Medical Costs of Patients Admitted with Dengue Fever in Muscat Governorate, Oman,” currently under publication with PLOS Neglected Tropical Diseases. She also serves as a Research Reviewer for Wiley journals, having reviewed multiple research articles under publication.