HIV Medical-care Status and Its Relationship to Hospital Facilities Utilization – South Carolina, 2004-2005

Background:
The un-insured or under-insured use the emergency department (ED) as their main source of primary medical-care and sometimes require inpatient hospitalization (IP) or ambulatory care (OP).

Objective:
To determine the hospital facilities utilization behavior of South Carolina's (SC) adult HIV-infected population based on their HIV medical-care status.

Method:
A data file of all adult SC residents reported to the HARS and alive at December 31st, 2003 was linked to statewide all payer health-care database to determine visits for 2004-2005. A hospital visit was categorized as either ED only, IP only, OP only or all. In HIV care was defined as receipt of a viral load test or CD4 cell count during calendar years 2004-2005. Logistic regression was used to estimate relationships between hospital utilization and demographic and behavioral factors.

Result:
Of the 13,042 HIV-infected adults, 5,130/13,042 (39%) made one or more visits to a hospital facility in 2004-2005 amounting to 35,959 visits (median 4; range 1–88).
Of these individuals, 2,027/5,130 (40%) visited EDs only, 439/5,130 (9%) IP only, 531/5,130 (10%) OP only, whereas 2,133/5,130 (42%) visited all. 2,407/5,130 (47%) individuals were not in HIV care.
Persons least likely to be in HIV care had more IP only visits (OR 0.65, 95%CI: 0.44, 0.97). Females making any visit were more likely to be in HIV care compared to men (OR 1.30, 95%CI: 1.08, 1.57) while persons with no identifiable risk making any visit were less likely in HIV care compared to heterosexuals with any visit (OR 0.71 95% CI: 0.58, 0.88).

Conclusion:
HIV-infected individuals not in HIV care continue to make visits to hospital facilities, and these visits represent missed opportunities for recruiting not in care persons back into HIV care.

Implications:
Programs to enhance linkage to HIV care should focus on individuals not in HIV care and hospital facilities should have improved HIV referral practices.