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AIDS Care. 2019 Sep;31(9):1131-1139. doi: 10.1080/09540121.2019.1576840. Epub 2019 Feb 19.

Ancillary service needs among persons new to HIV care and the relationship between needs and late presentation to care.

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a Johns Hopkins University School of Medicine , Baltimore , MD , USA.
b Department of Epidemiology and Biostatistics , Milken Institute School of Public Health, George Washington University , Washington , DC , USA.
c Johns Hopkins Bloomberg School of Public Health , Baltimore , MD , USA.
d Adult Ryan White Services , Johns Hopkins University , Baltimore , MD , USA.
e Harborview Medical Center , University of Washington , Seattle , WA , USA.
f Department of Health Behavior and Health Education , School of Public Health, University of Michigan , Ann Arbor , MI , USA.
g School of Medicine , Chapel Hill , NC , USA.
h Institute for Global Health and Infectious Diseases , University of North Carolina at Chapel Hill , Chapel Hill , NC , USA.
i Division of Infectious Diseases , University of Alabama at Birmingham (UAB) , Birmingham , AL , USA.


Ancillary service needs likely influence time to diagnosis and presentation for HIV care. The effect of both met and unmet needs on late presentation to HIV care is not well understood. We used baseline data from 348 people with HIV (PWH) with no prior HIV care who enrolled in iENGAGE (a randomized controlled trial (RCT) of an intervention to support retention in care) at one of four HIV clinics in the US. A standardized baseline questionnaire collected information on ancillary service needs, and whether each need was presently unmet. We examined covariates known to be associated with disease stage at presentation to care and their association with needs. We subsequently assessed the relationship of needs with CD4 accounting for those other covariates by estimating prevalence ratios (PR) using inverse probability weights. Most patients enrolling in the RCT were male (79%) and the majority were Black (62%); median age was 34 years. Prevalence of any reported individual need was 69%. One-third of the sample had a baseline CD4 cell count <200, 42% between 200 and 499 and 27% ≥500. There was no statistically significant association between need or unmet need and baseline CD4. In general, psychiatric health and SU issues (depression, anxiety, and drug use) were consistently associated with higher prevalence of need (met and unmet). Additionally, the Black race was associated with higher basic resource needs (housing: PR 1.67, 95%CI 1.08-2.59; transportation: PR 1.65, 95% CI 1.12-2.45). Ancillary service needs (met and unmet) were common among patients new to HIV care and impacted vulnerable subgroups. However, we found no evidence that reporting a specific individual need, whether met or unmet, was associated with a timely presentation to HIV care. The impact of needs on subsequent steps of the HIV care continuum will be examined with longitudinal data.


Retention; needs; treatment naive

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