INITIATION, RETENTION AND SURVIVAL IN HIV CLINICAL CARE: EFFECT OF RESIDENCE

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  • March 20, 2019
Creator
  • Lopes, Brettania
    • Affiliation: Gillings School of Global Public Health, Department of Epidemiology
Abstract
  • Late entry to human immunodeficiency virus (HIV) clinical care and inadequate engagement with care are associated with increased morbidity, mortality and secondary HIV transmission. Among HIV-infected persons in the U.S., approximately a quarter are diagnosed with acquired immune deficiency syndrome (AIDS) within 3 months of HIV diagnosis and a third within a year. After patients initiate HIV care, the majority miss clinic visits, 10-35% do not meet the Institute of Medicine’s (IOM) core retention indicator, and 20-50% become lost to follow up (LTFU). In the U.S., rural residence is associated with factors that may affect HIV care such as socioeconomic status, employment, educational level, and access to health insurance. Rural residence has been associated with delayed entry into care and increased mortality among some HIV-infected populations. However, to date little is known about the association between rural patient residence and HIV care retention and survival in the U.S. This study relied on the UNC CFAR HIV Clinical Cohort (UCHCC), a clinical cohort enrolling patients receiving primary HIV care at a large tertiary care facility in the Southeastern U.S. Patient residence was categorized as urban or rural using the United States Department of Agriculture Rural Urban Commuting Area codes (RUCAs). The median CD4 cell count at care entry was compared between patients residing in urban versus rural residences using multivariable linear regression. Poisson, log-binomial and Cox proportional hazards regression were used to estimate the association between residence and the incidence rate of missed visits, IOM indicator and time to loss to follow up (LTFU) and death, respectively. Results revealed the advanced progression of HIV-infection among a sizable group of patients. Rural in comparison to urban residence was associated with a lower likelihood of dropping out of care but was not associated with missed clinic visits or meeting the IOM retention indicator. Rural patients were at greater risk of mortality while in HIV care. This study provides some of the first evidence of the effects of residing in rural areas on HIV care access. Future studies focusing on geographic factors affecting HIV clinical care access and survival while in care are needed.
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  • In Copyright
Advisor
  • Miller, William
  • Mugavero, Michael
  • Eron, Joseph
  • Napravnik, Sonia
  • Meshnick, Steven R.
Degree
  • Doctor of Philosophy
Degree granting institution
  • University of North Carolina at Chapel Hill Graduate School
Graduation year
  • 2017
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