While debate continues when to initiate HIV antiretroviral therapy, it is recommended that clients enter into primary care as soon as possible after an initial HIV diagnosis. We examined demographic and clinical factors associated with delays in entering primary medical care. From 1994-1998, 408 clients with HIV/AIDS sought care in an economically poor region in central Arkansas served by Jefferson Comprehensive Care System (JCCS); only 162 (40%) were known to first test HIV positive and also seek care at JCCS. These 162 clients were predominantly male (77%), African-American (75%), and lacked health insurance (71%). One-third had a CD4+ count less than 200 cells/mL at time of diagnosis. Clients who were male, uninsured, or referred from the prison system had delayed entry into primary care. The median weeks from first knowledge HIV result to entry into care was 2.2 for women, and 6.5 for men; 25% of men did not seek care for more than 8 months. Uninsured patients delayed entry into care for a median of 5.8 weeks vs. 3.4 in insured individuals. There was no differences by race/ethnicity of the client. While time to entry into care decreased over time, CD4 lymphocyte counts at time of HIV diagnosis also declined: In 1994,the median CD4 count was 305 cells/mL and 208 in 1998. This analysis highlights several groups that might benefit from increased outreach and services to link them to primary care. Further promotion and encouragement of HIV testing earlier in the course of infection is also a priority.
Learning Objectives: Participants will be able to critically evaluate important factors associated with delayed entry into primary HIV care and assess strategies to improve access to care. Participants will also be able to evaluate the limitations of studies restricted to one site and geographic region
Keywords: Access to Health Care, Community-Oriented Primary Care
Presenting author's disclosure statement:
Organization/institution whose products or services will be discussed: None
I do not have any significant financial interest/arrangement or affiliation with any organization/institution whose products or services are being discussed in this session.