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Arch Intern Med. 2000 Sep 25;160(17):2614-22.

Delayed medical care after diagnosis in a US national probability sample of persons infected with human immunodeficiency virus.

Author information

1
University of Pennsylvania, General Internal Medicine, 1119 Blockley Hall, 423 Guardian Dr, Philadelphia, PA 19104-6021. bturner@mail.med.upenn.edu

Abstract

OBJECTIVE:

To identify health care and patient factors associated with delayed initial medical care for human immunodeficiency virus (HIV) infection.

DESIGN:

Survey of a national probability sample of persons with HIV in care.

SETTING:

Medical practices in the contiguous United States.

PATIENTS:

Cohort A (N = 1540) was diagnosed by February 1993 and was in care within 3 years; cohort B (N = 1960) was diagnosed by February 1995 and was in care within 1 year of diagnosis.

MAIN OUTCOME MEASURE:

More than 3- or 6-month delay.

RESULTS:

Delay of more than 3 months occurred for 29% of cohort A (median, 1 year) and 17% of cohort B. Having a usual source of care at diagnosis reduced delay, with adjusted odds ratios (ORs) of 0.61 (95% confidence interval [CI], 0.48-0.77) in cohort A and 0. 70 (95% CI, 0.50-0.99) in cohort B. Medicaid coverage at diagnosis showed lower adjusted ORs of delay compared with private insurance (cohort A: adjusted OR, 0.52; 95% CI, 0.30-0.92; cohort B: adjusted OR, 0.48; 95% CI, 0.27-0.85). Compared with whites, Latinos had 53% and 95% higher adjusted ORs of delay (P<.05) in cohorts A and B, respectively, and African Americans had a higher adjusted OR in cohort A (1.56; 95% CI, 1.19-2.04). The health care factors showed similar effects on delay of greater than 6 months.

CONCLUSIONS:

Medicaid insurance and a usual source of care were protective against delay after HIV diagnosis. After full adjustment, delay was still greater for Latinos and, to a lesser extent, African Americans compared with whites.

PMID:
10999975
DOI:
10.1001/archinte.160.17.2614
[Indexed for MEDLINE]

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