Patterns of engagement in care by HIV-infected adults: South Carolina, 2004-2006

AIDS. 2009 Mar 27;23(6):725-30. doi: 10.1097/QAD.0b013e328326f546.

Abstract

Objective: Identify factors associated with HIV care utilization in South Carolina.

Design: Cross-sectional analysis of South Carolina nonpregnant HIV-infected individuals (N = 13,042) for the period 1 January 2004 to 31 December 2006.

Methods: Reporting of HIV laboratory markers is legally mandated in South Carolina. Individuals with reported viral load tests or CD4 cell counts during a calendar year were defined as 'in HIV-medical care' that year. Care utilization categories were in care, care all 3 years; not-in-care (NIC), no care received; and transitional care, during some but not all years. Multinomial logistic regression using generalized logits was used to estimate relationships between care utilization and predictor variables.

Results: Five thousand, two hundred and seventeen (40.0%) of South Carolina HIV-infected adults were NIC and 3300 (25.3%) were in transitional care during 2004-2006. Although a larger number of black than white HIV-infected adults were NIC, adjusted odds for NIC status were lower among blacks than whites [adjusted odds ratio (AOR), 0.82; 95% confidence interval 0.74, 0.92)]. Women had lower odds of being NIC than men (AOR, 0.66; 95% confidence interval 0.58, 0.74). Compared with individuals 55 years or older, individuals who were 25-34 years old were most likely to demonstrate both the NIC (AOR, 1.85; 95% confidence interval 1.29, 2.65) and transitional (AOR, 1.85; 95% confidence interval 1.31, 2.62) care patterns.

Conclusion: Large proportions of the South Carolina HIV-infected adult population are not consistently accessing HIV-medical care. Targeted programs are needed to improve engagement for HIV-infected adults most likely to transition or not be in care.

MeSH terms

  • Adolescent
  • Adult
  • Age Factors
  • Cross-Sectional Studies
  • Female
  • HIV Infections / therapy*
  • Health Services / statistics & numerical data*
  • Humans
  • Male
  • Middle Aged
  • Patient Acceptance of Health Care / statistics & numerical data*
  • Sex Factors
  • South Carolina
  • Young Adult