Understanding the Care-Seeking Behavior of HIV Positive Persons in North Carolina

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DESCRIPTION (provided by applicant): Early presentation for medical care among HIV infected persons can improve the length and quality of life and reduce high-risk behavior. Despite these benefits, many adults enter care late in the course of HIV infection, countering the benefits of timely access to HIV services and missing opportunities for risk reduction. Linking HIV positive persons to high-quality care and prevention services has consequently been identified as a priority of the U.S. Centers for Disease Control and Prevention (CDC). The objective of this proposal is to examine the structural and individual factors that influence HIV testing and care-seeking behavior in North Carolina. In our first Aim, we will describe the effect of perceived social support on late presentation to medical care among HIV positive persons receiving care at the University of North Carolina (UNC) Infectious Disease (ID) Clinic. This secondary analysis will utilize data from the Clinical Socio-Demographic Survey and the Clinical and Research Database at the Center for AIDS Research (CFAR) at UNC. Social support will be quantified with a modified MOS Social Support Survey Scale and entered into a Cox proportional hazard model to determine its effect on delays seeking care after testing positive. In our second Aim, we propose a qualitative study to describe the attitudes and beliefs about HIV care among HIV-infected persons attending the UNC ID clinic who presented with clinically advanced illness. We plan to conduct semi-structured, individual qualitative interviews of HIV-infected persons who presented to care in the previous year with immunosuppression at their initial visit, defined as an indication for HAART therapy (CD4+ T-lymphocyte cell count <350 cells/mm3). The conceptual framework and interview instrument will be developed with constructs from the Health Belief Model. Recent testing recommendations issued by the CDC aim to incorporate HIV testing into routine medical care. A comprehensive understanding of how, when, and why newly diagnosed individuals enter care is therefore necessary to ensure that the new screening guidelines yield their maximum benefit. Towards this end, the findings from this research will elucidate barriers and facilitators to early HIV testing and medical care. Our findings will have direct public health implications for the evaluation of the HIV/AIDS referral system, post- test counseling messages, and bridging case management programs.