182658 Engagement in primary HIV-medical care:Retention in care issues in a Southern Rural State

Monday, October 27, 2008: 9:00 AM

Bankole A. Olatosi, MPH, PhD , Department of Healthcare Management and Organizational Development, Mount Olive College, Mount Olive, NC
Carleen H. Stoskopf, ScD , Graduate School of Public Health, San Diego State University, San Diego, CA
Janice C. Probst, PhD , University of South Carolina, South Carolina Rural Health Research Center, Columbia, SC
Amy B. Martin, DrPH , Department of Health Services Policy and Management, Arnold School of Public Health, University of South Carolina, Columbia, SC
Wayne A. Duffus, MD, PhD , HIV and STD Medicine, South Carolina Department of Health & Environmental Control, Columbia, SC
Background:We sought to ascertain factors associated with failure to remain in primary HIV medical care in a rural Southern state. Our conceptual framework was the Andersen behavioral health model.

Methods: We performed a retrospective cohort analysis of the care status of all HIV-infected, non-pregnant adults reported to the South Carolina HIV/AIDS Reporting System during 2004-2006 (n=13,042). Persons receiving a viral load test or CD4 cell count during a 12-month period were defined as being in care for that period. Care status categories were: In Care (IC), care all three years; Not In Care (NIC) no care across the period; and Transitioning (TC), care received during one or more years but not consistently. Reporting of HIV laboratory markers is mandatory by law in SC. We report multinomial logistic regression results.

Results: Only 34.7% of HIV-infected adults remained in care across the study period. In unadjusted analysis, blacks were less likely than whites to be NIC rather than IC (OR, 0.77; C.I, 0.70, 0.84); women were more likely to be NIC than were men (OR, 1.36; C.I, 1.25, 1.49). In adjusted analysis, blacks continued to be less likely than whites to be NIC (OR, 0.88; C.I, 0.78, 0.99), but women had lower odds of being NIC than men (OR, 0.79; C.I, 0.69, 0.90).

Conclusions: Significant proportions of the South Carolina HIV-infected adult population was not in care or transitioned in and out of care. Targeted programs are needed for the populations most likely to transit or not be in care.

Learning Objectives:
1) To identify possible states of engagement an HIV-infected person can have in a population sample. 2) To determine associations and strength of associations for factors predicting different states of engagement. 3) To describe population characteristics useful as high risk flags for persons least likely to remain in care.

Keywords: HIV/AIDS, Health Care Utilization

Presenting author's disclosure statement:

Qualified on the content I am responsible for because: This work is original work done by me without any conflict of interest or commercial support.
Any relevant financial relationships? No

I agree to comply with the American Public Health Association Conflict of Interest and Commercial Support Guidelines, and to disclose to the participants any off-label or experimental uses of a commercial product or service discussed in my presentation.