Factors associated with delayed entry into primary HIV medical care

[Guest guest]

Factors associated with delayed entry into primary HIV medical care after HIV

diagnosis

Bamford, P; Ehrenkranz, D; Eberhart, G; Shpaner, Mark;

Brady, Kathleen A

AIDS: 27 March 2010 - Volume 24 - Issue 6 - p 928–930

Research Letters

Abstract

The aim of the study was to assess the median time between HIV diagnosis and

entry into primary HIV medical care in a large urban area and to assess the

potential individual, diagnosing facility, and community level factors

influencing entry into care.

One thousand two hundred and sixty-six individuals diagnosed with HIV in

Philadelphia between 1 July 2005 and 30 June 2006 were followed until entry into

care through 15 June 2007.

Time to entry into care was calculated as a survival time variable and was

defined as the time in months between the date of HIV diagnosis and the date

more than 3 weeks after diagnosis when a CD4 cell count or percentage and/or HIV

viral load were obtained.

The median time to entry into care for all individuals was 8 months, with a

range of 1–26 months.

Factors associated with delayed entry into care included age more than 40 years

[hazard ratio (HR) = 0.85; 95% confidence interval (CI) = 0.75–0.97] and

diagnosis as an inpatient in the hospital (HR = 0.37; 95% CI = 0.37–0.57).

Factors associated with earlier entry into care included Hispanic ethnicity (HR

= 1.39; 95% CI = 1.05–1.84), male sex with men as HIV transmission risk factor

(HR = 1.27; 95% CI = 1.03–1.56), and residence in a census tract with a high

poverty rate (HR = 1.68; 95% CI = 1.22–2.30).

Individuals newly diagnosed with HIV in Philadelphia demonstrated marked delays

in accessing care highlighting the tremendous need for interventions to improve

overall linkage.

These interventions should especially be targeted at those aged more than 40

years and those diagnosed in the hospital.