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Original Article

Factors Associated with Delayed Initiation of HIV Medical Care Among Infected Persons Attending a Southern HIV/AIDS Clinic

Christopher S. Krawczyk, PHD, Ellen Funkhouser ms, drph, J Michael Kilby, MD, Richard A. Kaslow, MD, mph, Amita K. Bey mph, Sten H. Vermund, MD, PHD
Volume: 99 Issue: 5 May, 2006

Abstract:

Background: Despite the proven benefits conferred by early human immunodeficiency virus (HIV) diagnosis and presentation to care, delays in HIV medical care are common; these delays are not fully understood, especially in the southern United States.


Methods: We evaluated the extent of, and characteristics associated with, delayed presentation to HIV care among 1,209 patients at an HIV/AIDS Outpatient Clinic in Birmingham, Alabama between 1996 and 2005.


Results: Two out of five (41.2%) patients first engaged care only after they had progressed to CDC-defined AIDS. Among these, 53.6% were diagnosed with HIV in the year preceding entry to care. Recent presentation (2002 – 2005), male sex, age ≥25, Medicare or Medicaid insurance coverage, and presentation within six months of HIV diagnosis were independently associated with initiating care after progression to AIDS.


Conclusions: A high proportion of patients entered clinical care after experiencing substantial disease progression. Interventions that effectively improve the timing of HIV diagnosis and presentation to care are needed.


Key Points


* Nearly half of all subjects (41.2%) first engaged with an HIV medical provider after they had already progressed to CDC-defined AIDS.


* Among these, 53.6% had received their initial HIV diagnosis in the year preceding entry to care, indicating substantial HIV diagnostic delay in our patient population.


* Characteristics associated with delayed presentation to care included presentation in the most recent time period (2002 to 2005), male sex, age ≥ 25 years old, and Medicare or Medicaid insurance coverage.

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