Factors Associated with Intermittent HIV Care among a Representative Sample in Los Angeles County, California

Background: The successful management of HIV-disease includes regular primary care visits per Public Health Service treatment guidelines (DHHS 2006). However, failure to engage in consistent HIV care has been observed among patients in the US (Shapiro 2000). Factors associated with intermittent HIV care among a representative sample of patients in Los Angeles County (LAC) are examined.

Methods: A representative sample of HIV-infected adults receiving care from January to April 2007 was identified using a 3-stage sampling design. In LAC, patients who had fewer than 2 primary care visits in 9 months were considered in “intermittent care” (n=202); patients with 2 or more visits in this timeframe were considered in “regular care” (n=127). Odds ratios (OR) and t-tests were calculated to examine socio-demographic and clinical characteristics associated with intermittent care.

Results: Factors associated with intermittent care included: current younger age (p=.001), younger age at HIV diagnosis (p=.003), and HIV only status (non-AIDS) (OR=1.7, 95% CI=1.1-2.8). Among those with AIDS, the mean years between an HIV and AIDS diagnosis was greater for those in intermittent care (p=.006). No differences were observed with regard to health insurance status or type, or race/ethnicity.

Conclusions/Implications: HIV patients who were younger, without an AIDS diagnosis, and with more years between an HIV and AIDS diagnosis, were more likely to be in intermittent HIV care. These data are useful for identifying HIV-positive persons who are most likely to fall out of regular care, and may require additional interventions to help them maintain consistent care.