Determinants of Late Presentation for HIV Treatment and Care
Creators: name: University Of California Office Of The President
Publisher: name: University of California Office of the President
publisherIdentifier: https://ror.org/00dmfq477
publisherIdentifierScheme: ROR
Year: 2024

description: Ensuring timely access to care for persons living with HIV is a public health imperative in industrialized countries. Highly active antiretroviral therapy has proved to be highly effective in delaying AIDS onset and has led to substantial reductions in AIDS incidence and mortality. However, despite the widespread availability of HAART in the United States, including through the AIDS Drug Assistance Program, Medicare and Medicaid, over 44,000 new AIDS cases were reported in 2002. Initiating medical care late in the course of HIV infection is associated with greater morbidity and mortality, and with poorer response to HAART. Persons with unrecognized or untreated HIV infection are at higher risk of transmitting it to others. Race, poverty, language, concerns about stigmatization, and being unaware of risk may also be factors that prevent people from seeking care for HIV until advanced disease. Identification of barriers and facilitators associated with late presentation and seeking care is therefore crucial to developing targeted interventions aimed at encouraging early entrance into HIV care, improving health outcomes and quality of life, and reducing disparities in HIV disease burden. We propose to investigate factors associated with delays in seeking HIV care and in initiation of HIV treatment among patients at the East Bay AIDS Center and the Alameda County Medical Center’s HIV Services Division, the two largest providers of HIV care in the East San Francsico Bay Area. These clinics have served the HIV-affected community in the East Bay for over 20 years in medical, social and research arenas, and are the central hubs of a network of community-based providers helping HIV+ individuals meet the challenges of their health status and social environment. In collaboration with researchers at the Center for AIDS Prevention Studies, we will design, develop and field a survey on risk factors for late presentation, demographics, as well as beliefs, attitudes and concerns related to HIV treatment and care. The survey will be preceded a series of interviews and focus groups to identify key themes and patterns in our East Bay community related to HIV testing and initiating care. Qualitative data from this preliminary stage will provide a comprehensive narrative of the issues related to delays in accessing HIV care, and will inform survey design. Specifically, to better understand the determinants that lead HIV+ individuals to present late for care, we propose a survey in which our objectives will be to: 1) Identify factors related to low CD4 count at first presentation in clinic. 2) Estimate the time intervals between initial infection, awareness of risk or illness, HIV testing, presentation for medical treatment, and initiation of HAART. 3) Determine which factors contribute to prolonging these intervals. 4) Provide profiles of individuals at high risk for late presentation for HIV care among a diverse, urban HIV+ population. This collaboration will enhance our ability to investigate issues critical to our local patient population by providing dedicated resources for research activities, linkages in staff capacity between clinics, and expertise from academic partners. We hope to generate an increasingly sophisticated model of how social and contextual factors mediate the impact of HIV, and through that model to find ways to allow our patients and community to maximally benefit from the enormous advances in HIV prevention and treatment.