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

Krawczyk, Christopher; Funkhouser, Ellen; Kilby, J. Michael; Kaslow, Richard A.; Bey, Amita; Vermund, Sten H.

doi:10.1097/01.smj.0000215639.59563.83

Cited by 55 publications

(58 citation statements)

References 68 publications

(44 reference statements)

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“…* In response, several organizations (e.g., AAHIVM, HIV Medicine Association, the AIDS Education and Training Centers Program of the Ryan White CARE Act, HealthHIV) have increased their efforts to: (1) draw students and clinicians into HIV medicine and increase provider diversity, (2) advocate for HIVrelated loan repayment programs and provider reimbursement changes, and (3) provide up-to-date clinical training for primary care providers. Finally, the geographic distribution of clinicians must also change in response to the evolving epidemic as infections continue to increase in medically underserved rural and innercity areas and the South (Figure 2)-regions where patients often delay care [32][33][34] and HIV treatment centers have difficulty recruiting and retaining providers. 27 * Some studies have found that provider gender and race affect patient satisfaction and health service utilization.…”

Section: Changing Providers: New Responsibilities Impending Shortagesmentioning

confidence: 99%

An Epidemic in Evolution: The Need for New Models of HIV Care in the Chronic Disease Era

2011

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Since the beginning of the AIDS epidemic, models of HIV care have needed to be invented or modified as the needs of patients and communities evolved. Early in the epidemic, primary care and palliative care predominated; subsequently, the emergence of effective therapy for HIV infection led to further specialization and a focus on increasingly complex antiretroviral therapy as the cornerstone of effective HIV care. Over the past decade, factors including (1) an aging, long-surviving population; (2) multiple co-morbidities; (3) polypharmacy; and (4) the need for chronic disease management have led to a need for further evolution of HIV care models. Moreover, geographic diffusion; persistent disparities in timely HIV diagnosis, treatment access, and outcomes; and the aging of the HIV provider workforce also suggest the importance of reincorporating primary care providers into the spectrum of HIV care in the current era. Although some HIV-dedicated treatment centers offer comprehensive medical services, other models of HIV care potentially exist and should be developed and evaluated. In particular, primary care-and community-based collaborative practices-where HIV experts or specialists are incorporated into existing health centers-are one approach that combines the benefits of HIV-specific expertise and comprehensive primary care using an integrated, patient-centered approach.

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Section: Changing Providers: New Responsibilities Impending Shortagesmentioning

confidence: 99%

An Epidemic in Evolution: The Need for New Models of HIV Care in the Chronic Disease Era

2011

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“…Because young people aged 15-24 years were least likely to have delayed diagnosis 18 and prevalence of viral suppression (13%) was lowest among those aged 18-24 years, 19 the higher risk of progression to AIDS largely suggests a lack of adequate access to care or adherence to HIV treatment among young people living with HIV. 1,[20][21][22][23] Higher risks of progression to AIDS and death among males with infection attributed to IDU or heterosexual contact, and among females with infection attributed to IDU, might be due to delayed diagnosis, 1 delayed linkage to HIV medical care, 1,24,25 less use of health services among heterosexuals and those who inject drugs, 14,26 and high-risk lifestyle factors or death from comorbidity conditions such as hepatitis C coinfection among people who inject drugs. 27,28 Observed disparities in the risks of progression to AIDS and death among people of multiple races and African Americans might reflect the disparities in delayed diagnosis, 18 access or linkage to medical care, 26 adherence to treatment, 22 and other socioeconomic factors that might affect access to HIV care.…”

Section: Discussionmentioning

confidence: 99%

“…1,[20][21][22][23] Higher risks of progression to AIDS and death among males with infection attributed to IDU or heterosexual contact, and among females with infection attributed to IDU, might be due to delayed diagnosis, 1 delayed linkage to HIV medical care, 1,24,25 less use of health services among heterosexuals and those who inject drugs, 14,26 and high-risk lifestyle factors or death from comorbidity conditions such as hepatitis C coinfection among people who inject drugs. 27,28 Observed disparities in the risks of progression to AIDS and death among people of multiple races and African Americans might reflect the disparities in delayed diagnosis, 18 access or linkage to medical care, 26 adherence to treatment, 22 and other socioeconomic factors that might affect access to HIV care. 20,21,26,29 In addition, the higher risks of progression to AIDS and death in the South may reflect their delayed access to HAART or decreased likelihood of using HAART.…”

Section: Discussionmentioning

confidence: 99%

Trends and Differences among Three New Indicators of HIV Infection Progression

Song

Hernández

et al. 2015

Public Health Rep

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Objective. This study proposes three indicators of, and assesses the disparities and trends in, the risk of HIV infection progression among people living with diagnosed HIV infection in the United States.Methods. Using data reported to national HIV surveillance through June 2012, we calculated the AIDS diagnosis hazard, HIV (including AIDS) death hazard, and AIDS death hazard for people living with diagnosed HIV infection for each calendar year from 1997 to 2010. We also calculated a stratified hazard in 2010 by age, race/ethnicity, mode of transmission, region of residence at diagnosis, and year of diagnosis.Results. The risk of HIV infection progression among people living with diagnosed HIV infection decreased significantly from 1997 to 2010. The risks of progression to AIDS and death in 2010 were higher among African Americans and people of multiple races, males exposed through injection drug use (IDU) or heterosexual contact, females exposed through IDU, people residing in the South at diagnosis, and people diagnosed in 2009 compared with white individuals, men who have sex with men, females with infection attributed to heterosexual contact, those residing in the Northeast, and those diagnosed in previous years, respectively. People aged 15-29 years had the highest AIDS diagnosis hazard in 2010.Conclusion. Continued efforts are needed to ensure early HIV diagnosis as well as initial linkage to and continued engagement in HIV medical care among all people living with HIV. Targeted interventions are needed to improve healthcare and supportive services for those with worse health outcomes.

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“…Aer the �rst six months of ART, this same association was only found at the 12-month time point ( ) (Table 2). 18,20) and the difference between these times was statistically signi�cant (log-rank, ) ( Figure 1). Statistically signi�cant difference between patients having baseline OL and those without baseline OL in the strati�ed analysis (baseline viral load 10,000 copies/mL group versus baseline viral load ≥10,000 copies/mL group) (log-rank, ) was also found.…”

Section: Oral Lesions Mirroring Viral Load Burden At Baseline and 12mentioning

confidence: 99%

“…e same proportions were calculated at 6, 12, 18, and 24 months. e nearest value to the end of each period (6,12,18, and 24 months aer initial visit) was recorded.…”

Section: Statistical Analysesmentioning

confidence: 99%

Oral Lesions: Poor Markers of Virologic Failure in HIV-Infected Patients on Antiretroviral Therapy

Tamí-Maury

Willig

Jolly

et al. 2013

ISRN Infectious Diseases

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e objective of this study was to assess the use of HIV-oral lesions (OLs) as markers of virologic failure (VF) in response to antiretroviral therapy (ART). Concurrent virologic status was compared between 744 individuals with and without OL ( 2 ). Time to VF between OL groups was compared (Kaplan-Meier), and baseline factors associated with VF were determined (Cox Hazard models). Sensitivity, speci�city, positive predictive value, and negative predictive value were also computed. At baseline and 12 months, individuals with OL were more likely to have viral load ≥ 10, 000 copies/ml compared to patients without OL ( 0 01). Time to VF between patients with baseline OL (mean: 17 months, 95% CI 16-18) and patients without baseline OL (mean: 19 months, 95% CI: 18-20) was statistically different. Patients who were African-American (HR 1.356; 95% CI: 1.045-0.759), ARTexperienced (HR 2.298; 95% CI: 1.743-3.030), had mental disorders (HR 1.410; 95% CI: 1.078-1.843), and had high baseline viral load (HR 2.82; 95% CI: 1.661-3.137), were more likely to have VF a�er the �rst six months of ART. OL had a moderate positive predictive value for concurrent VF at 6 months (45.5%) and 18 months (33.3%), but a strong positive predictive value at 12 months (80.0%) and 24 months (100.0%). Findings of this study suggest that OLs could be poor predictors of VF in HIV-infected patients on ART therapy.

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

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.

Cited by 55 publications

References 68 publications

An Epidemic in Evolution: The Need for New Models of HIV Care in the Chronic Disease Era

An Epidemic in Evolution: The Need for New Models of HIV Care in the Chronic Disease Era

Trends and Differences among Three New Indicators of HIV Infection Progression

Oral Lesions: Poor Markers of Virologic Failure in HIV-Infected Patients on Antiretroviral Therapy

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