HIV Care Initiation Delay Among Rural Residents in the Southeastern United States, 1996 to 2012.
HIV Care Initiation Delay Among Rural Residents in the Southeastern United States, 1996 to 2012.
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DOI：
10.1097/qai.0000000000001483
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发表时间：
2017-10-01
期刊：
影响因子：
--
通讯作者：
Napravnik S
中科院分区：
文献类型：
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作者：
Lopes BLW;Eron JJ Jr;Mugavero MJ;Miller WC;Napravnik S
推迟艾滋病毒护理的启动可能会导致更高的发病率、死亡率和进一步的艾滋病毒传播。农村居住可能与延迟诊断和与护理的联系有关，具有负面的临床结果。在美国东南部的一个大型HIV临床队列中，研究农村患者居住地与HIV护理开始时CD 4细胞计数之间的相关性。我们纳入了1996-2012年期间开始护理的HIV感染患者，这些患者具有可地理编码的地址，并且之前没有HIV临床护理史。使用美国农业部农村城市通勤区号将患者居住地分类为城市或农村。多变量线性回归模型拟合，以估计艾滋病毒护理开始时患者居住和CD 4细胞计数之间的关联。在符合研究入选标准的1396例患者中，988例具有可地理编码的地址。总体而言，35%的患者居住在农村地区，接受HIV治疗，平均CD 4细胞计数为351个细胞/mm 3（标准差[SD]，290）。护理启动平均CD 4细胞计数从1996-2003年的329个细胞/mm 3（SD，283）增加到2008-2012年的391个细胞/mm 3（SD，292）（P=0.006）。与城市患者相比，农村患者的CD 4细胞计数较低，未校正和校正的平均差异分别为-48个细胞/mm 3（95%置信区间[CI]，-86，-10）和-37个细胞/mm 3（95% CI，-73，-2），在历年中一致观察到。在美国东南部队列中，低CD 4细胞计数的HIV护理启动很常见，在农村地区居民中更常见。
Delaying HIV care initiation may lead to greater morbidity, mortality and further HIV transmission. Rural residence may be associated with delayed diagnosis and linkage to care, with negative clinical outcomes. To examine the association between rural patient residence and CD4 cell count at HIV care initiation in a large HIV clinical cohort in the Southeastern United States. We included HIV-infected patients who initiated care between 1996-2012 with a geocodable address and no prior history of HIV clinical care. Patient residence was categorized as urban or rural using United States Department of Agriculture Rural Urban Commuting Area codes. Multivariable linear regression models were fit to estimate the association between patient residence and CD4 cell count at HIV care initiation. Among 1396 patients who met study inclusion criteria, 988 had a geocodable address. Overall 35% of patients resided in rural areas and presented to HIV care with a mean CD4 cell count of 351 cells/mm3 (Standard Deviation [SD], 290). Care initiation mean CD4 cell counts increased from 329 cells/mm3 (SD, 283) in 1996-2003 to 391 cells/mm3 (SD, 292) in 2008-2012 (P=0.006). Rural in comparison to urban patients presented with lower CD4 cell counts with an unadjusted and adjusted mean difference of -48 cells/mm3 (95% Confidence Interval [CI], -86, -10) and -37 cells/mm3 (95% CI, -73, -2), respectively, consistently observed across calendar years. HIV care initiation at low CD4 cell counts was common in this Southeastern US cohort and more common among rural area residents.