Associations of Rural Residence With Timing of HIV Diagnosis and Stage of Disease at Diagnosis, South Carolina 2001-2005
Associations of Rural Residence With Timing of HIV Diagnosis and Stage of Disease at Diagnosis, South Carolina 2001-2005
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DOI：
10.1111/j.1748-0361.2010.00271.x
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发表时间：
2010-03-01
影响因子：
4.9
通讯作者：
Duffus, Wayne A.
中科院分区：
文献类型：
--
作者：
Weis, Kristina E.;Liese, Angela D.;Duffus, Wayne A.
内容：美国南部的农村地区面临着许多挑战，包括有限的医疗保健服务和耻辱，这可能会导致农村居民中的艾滋病诊断延迟。目的：调查农村居民与艾滋病诊断时间和诊断时疾病阶段的关系。艾滋病毒诊断的时间被归类为获得性免疫缺陷综合征的诊断在1年内的第一次阳性艾滋病毒检测或艾滋病毒。疾病的分期基于诊断后1年内采集的初始CD 4 + T细胞计数。如果最大城市的人口至少为25 000人，则艾滋病毒诊断时居住的县被列为城市;否则被列为农村。结果：2001 ~ 2005年，共确诊HIV感染者4,137例，其中HIV感染者100例，HIV感染者100例，HIV感染者100例。其中1 129人（27%）为农村居民，3 008人（73%）为城市居民。在农村居民中，533人（47%）被诊断为晚期，而城市居民为1，258人（42%）。农村居民被诊断为晚期的可能性更大（OR 1.19 [95%CI，1.02-1.38]）。农村居住与较低的初始CD 4 + T细胞计数相关（P = 0.01），但调整后无相关性（P > 0.05）。结论：农村居住是HIV晚期诊断的危险因素。这可能导致抗逆转录病毒药物治疗反应降低，发病率和死亡率增加，农村居民中艾滋病毒传播风险增加。需要制定新的检测战略，应对农村地区艾滋病毒检测和诊断方面的挑战。
Context: Rural areas in the southern United States face many challenges, including limited access to health care services and stigma, which may lead to later HIV diagnosis among rural residents.Purpose: To investigate the associations of rural residence with timing of HIV diagnosis and stage of disease at diagnosis.Methods: Timing of HIV diagnosis was categorized as a diagnosis of acquired immune deficiency syndrome within 1 year of a first positive HIV test or HIV-only. Stage of disease was based on initial CD4+ T-cell count taken within 1 year of diagnosis. County of residence at HIV diagnosis was classified as urban if the population of the largest city was at least 25,000; it was classified as rural otherwise. Logistic regression was used to analyze timing of HIV diagnosis, and analysis of covariance was used to analyze stage of disease.Findings: From 2001 to 2005, 4,137 individuals were diagnosed with HIV infection. Of these, 1,129 (27%) were rural and 3,008 (73%) were urban residents. Among rural residents, 533 (47%) were diagnosed late, compared with 1,258 (42%) urban residents. Rural residents were significantly more likely to be diagnosed late (OR 1.19 [95% CI, 1.02-1.38]). Rural residence was associated with lower initial CD4+ T-cell count in crude analysis (P = .01) but not after adjustment (P > .05).Conclusions: Rural residence is a risk factor for late HIV diagnosis. This may lead to reduced treatment response to antiretroviral medications, increased morbidity and mortality, and greater HIV transmission risks among rural residents. New testing strategies are needed that address challenges to HIV testing and diagnosis specific to rural areas.