Journal
SOUTHERN MEDICAL JOURNAL
Volume 99, Issue 5, Pages 472-481Publisher
LIPPINCOTT WILLIAMS & WILKINS
DOI: 10.1097/01.smj.0000215639.59563.83
Keywords
HIV; AIDS; health care; access; Alabama; delay
Categories
Funding
- NCRR NIH HHS [M01 RR000032] Funding Source: Medline
- NIAID NIH HHS [5P30AI027767-18, AI41530, U01 AI041530-03, P30 AI027767, U01 AI041530] Funding Source: Medline
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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.
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