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Delayed Medical Care After Diagnosis in a US National Probability Sample of Persons Infected With Human Immunodeficiency Virus
Barbara J. Turner, MD, MSEd;
William E. Cunningham, MD, MPH;
Naihua Duan, PhD;
Ronald M. Andersen, PhD;
Martin F. Shapiro, MD, PhD;
Sam A. Bozzette, MD, PhD;
Terry Nakazono, MA;
Sally Morton, PhD;
Steven Crystal, PhD;
Patti St Clair, BS;
Michael Stein, MD;
Sally Zierler, DrPH, MEd;
for the HIV Cost and Services Utilization Study (HCSUS) Access Research Team Members
Arch Intern Med. 2000;160:2614-2622.
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.
Members of the HCSUS Access Research Team are as follows: Ronald M. Andersen, PhD, Chair, University of California Los Angeles (UCLA) School of Public Health, Los Angeles; William E. Cunningham, MD, MPH, Co-Chair, UCLA School of Public Health; Stephen Crystal, PhD, Rutgers University Institute for Health, New Brunswick, NJ; Kevin Heslin, MS, UCLA School of Public Health; Kiyoshi Kuromiya (deceased), Critical Path AIDS Project, Philadelphia, Pa; Sally C. Morton, PhD, RAND, Santa Monica, Calif; Terry Nakazono, MA, UCLA School of Public Health; Martin F. Shapiro, MD, PhD, UCLA School of Medicine, Los Angeles; Michael Stein, MD, Rhode Island Hospital, Providence; Barbara J. Turner, MD, MSEd, University of Pennsylvania, Philadelphia; and Sally Zierler, DrPH, MEd, Brown University, Providence.
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