Online Program

Delayers and Dropouts : Dropping Off the Care Cascade

Sunday, November 1, 2015

Angela A. Aidala, PhD, Mailman School of Pubic Health, Columbia University, New York, NY
Maiko Yomogida, Department of Sociomedical Sciences, Columbia University, New York, NY
Objectives.   We examined patterns, predictors, and self-reported reasons for delaying initial entry into HIV care (>3 months) and/or one or more episodes of dropping out’ of care (>6 months) among persons living with HIV (PLWH) in New York City and northern suburban.

Methods.  Data are provided by a cohort study of PLWH recruited using probability sampling from HIV service settings.  Comprehensive in-person interviews were conducted every 12-18mos.   Logistic regression analyses examine delayers based on interviews conducted 2009-12,  and random effect logistic models conducted for the dropouts analyses using interviews conducted from 2001-2014 (n=1586).   Models include a wide range of individual, situational, and service need variables.   Qualitative analyses identified reasons for delaying entry or dropping out of care.  

Results.    Diagnosis after 2002 is associated with lower odds of delayed entry into care.   Homelessness at diagnosis is associated with higher odds (OR 2.05) and having a regular source of medical care prior to diagnosis (OR 0.58) with lower odds of delayed care.   Recent drug use (OR 2.78), mental health symptoms (OR 1.39),  unstable housing, food insecurity, and transportation needs are associated with significantly greater odds of dropping out of care.   Receipt of case management services is associated with lower odds of dropping out of care, especially case management oriented toward addressing social service needs (OR 0. 60).

 Conclusions.    Contextual factors, behavioral health and social service needs, and services to address such needs, are the most important predictors of delayed entry into HIV medical care or lack of retention in care over time.

Learning Areas:

Program planning
Social and behavioral sciences

Learning Objectives:
Describe the importance of situational or contextual factors as influencing risk of delayed entry into HIV medical care after diagnosis and lack of retention in care over time. Identify services that are associated with facilitating timely entry into care and/or sustained engagement in HIV medical care over time.

Keyword(s): HIV/AIDS, Treatment Adherence

Presenting author's disclosure statement:

Qualified on the content I am responsible for because: I am a public health associate with over 10 years of experience focusing on the HIV, Mental Health, Substance Abuse, Homelessness, and Criminal Justice service research. My interest is to identify barriers to care among the marginalized population and to inform policies and practices.
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.

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