Delayed Medical Care After Diagnosis in a US National Probability Sample of Persons Infected With Human Immunodeficiency Virus

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dc.contributorVirginia Techen
dc.contributor.authorTurner, Barbara J.en
dc.contributor.authorCunningham, William E.en
dc.contributor.authorDuan, Naihuaen
dc.contributor.authorAndersen, Ronald M.en
dc.contributor.authorShapiro, Martin F.en
dc.contributor.authorBozzette, Samuel A.en
dc.contributor.authorNakazono, Terryen
dc.contributor.authorMorton, Sally C.en
dc.contributor.authorCrystal, Stevenen
dc.contributor.authorSt. Clair, Pattien
dc.contributor.authorStein, Michaelen
dc.contributor.authorZierler, Sallyen
dc.date.accessioned2017-10-19T15:36:57Zen
dc.date.available2017-10-19T15:36:57Zen
dc.date.issued2000-09-25en
dc.description.abstractObjective: 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.en
dc.description.sponsorshipThe HIV Cost and Services Utilization Study is being conducted under cooperative agreement HS08578 (Dr Shapiro, principal investigator; Dr Bozzette, co–principal investigator) between RAND and the Agency for Health Care Policy and Research. Substantial additional support for this agreement was provided by the Health Resource and Services Administration, Rockville, Md; the National Institute for Mental Health, the National Institute on Drug Abuse, and the National Institutes of Health Office of Research on Minority Health through the National Institute for Dental Research, Bethesda, Md. Additional support was provided by the Robert Wood Johnson Foundation, Princeton, NJ; Merck and Co, Whitehouse Station, NJ; Glaxo-Wellcome, Research Triangle Park, NC; and the National Institute on Aging, Bethesda.en
dc.identifier.doihttps://doi.org/10.1001/archinte.160.17.2614en
dc.identifier.issue17en
dc.identifier.urihttp://hdl.handle.net/10919/79715en
dc.identifier.volume160en
dc.language.isoen_USen
dc.publisherAMAen
dc.rightsIn Copyrighten
dc.rights.urihttp://rightsstatements.org/vocab/InC/1.0/en
dc.titleDelayed Medical Care After Diagnosis in a US National Probability Sample of Persons Infected With Human Immunodeficiency Virusen
dc.title.serialArchives of Internal Medicineen
dc.typeArticle - Refereeden

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Destination Area: Global Systems Science (GSS)