Wednesday, March 12, 2008
Retention in HIV medical-care is associated with improved health outcomes and helps limit HIV transmission because patients can be educated on ways to modify risky behaviors
To identify characteristics of South Carolina's (SC) adult HIV-infected population associated with HIV medical-care status in 2004.
Characteristics of all HIV-infected adults reported to the HIV/AIDS Reporting System (HARS) database who were alive on December 31st, 2003 was used in a cross-sectional study design. Reporting of HIV laboratory markers is mandatory by law and in HIV medical-care was defined as receipt of a viral load or CD4 cell count during calendar year 2004. Logistic regression was used to estimate relationships between care status and demographic and transmission factors.
Of the 13,042 HIV-infected adults, 7,303 (56%) were not in HIV medical-care in 2004. Individuals more likely to be in care were: African-Americans (OR 1.21, 95%CI: 1.10, 1.33) compared with Whites and females (OR 1.39, 95%CI: 1.26, 1.54) compared with males. Individuals less likely to be in care were: persons 25-34 years old (OR 0.71, 95%CI: 0.61, 0.83) compared to those 55 years or older; men who have sex with men (MSM)/intravenous drug users (IDU) (OR 0.73, 95%CI: 0.58, 0.91), IDU only (OR 0.76, 95%CI: 0.67, 0.87), and persons with no identifiable risk (OR 0.60, 95%CI: 0.54, 0.67) compared to those reporting heterosexual contact as their mode of transmission.
This population-based study shows that a high percentage of SC's adult HIV-infected population is not in HIV medical-care. Both decreasing mortality and controlling the HIV epidemic will not be successful in SC unless these individuals are brought into HIV medical care.
Future research is needed to identify reasons why HIV-infected adults remain out of HIV care and policy should focus on methods to enhance linkage and retention in care.