Determinants of Longer Time From HIV Result to Enrollment in Publicly Funded Care and Treatment in California by Race/Ethnicity and Behavioral Risk

When prevention efforts fail, control of the HIV epidemic depends on linking infected persons from counseling and testing programs to appropriate care and treatment as soon as possible, according to the authors. Although the benefits of early care and treatment include better quality of life and delay of AIDS, such benefits are not always equally distributed across groups. The current study examined time from first positive HIV result until enrollment into care and treatment by demographics, risk behaviors, and other characteristics, using data from clients enrolled at an Early Intervention Program site in California since 1997, when HAART became widely available, through July 2000. EIP is California's publicly funded HIV care and treatment program. There are 30 sites throughout the state. The researchers examined the influence of the source of care and treatment referral as a potentially important intervening variable.

The study investigated 2,222 persons enrolled at EIP, using the number of days between the client's self-reported date of his or her first HIV positive test result to client enrollment in the program as the dependent variable. Independent variables included race/ethnicity, behavioral risk, gender, age at HIV diagnosis, family size, employment status, primary source of health care, health insurance, public assistance and source of referral to an EIP site.

The authors performed multivariate analyses to identify those at greater risk for delay of entry into care and treatment. Most (41.6 percent) clients were Latino; roughly one-third (34.3 percent) were white; one-fifth (19.1 percent) were African American. Men who have sex with men comprised 38.8 percent of the study group, and 27.9 percent were heterosexuals. Three-fourth (75.6 percent) of the study group were male. Most of the clients studied (58.3 percent) were unemployed. Approximately one-third (32.4 percent) did not report a primary source of health care, and over 6 in 10 (64.6 percent) had no form of health insurance when they enrolled in EIP. Roughly 1 in 5 (19.4 percent) received some form of public assistance, and 62.2 percent of clients lived by themselves at enrollment.

The investigators found no statistical variation across racial or ethnic groups in measures of time from HIV diagnosis to accessing publicly funded care and treatment among clients who were not enrolled in EIP on the same day they were diagnosed. Latinos, however, were more likely than whites to enroll in the California EIP on the same day they were diagnosed. The authors also found history of injection drug use related to greater delay in patients seeking care and treatment from EIP. Overall, they found a decrease in the time interval between HIV diagnosis and enrollment in EIP once HAART became available at all 30 EIP sites. "We strongly believe that the trend in decrease of days from HIV diagnosis to care and treatment is due to improvements in coordination of services between HIV counseling and testing programs and the EIP," they wrote.

Clients referred through public clinics or hospitals enrolled in care sooner than those referred to EIP through private physicians, clinics or hospitals. "The California EIP represents a model for programs seeking equity in access to HIV care and treatment across racial and ethnic groups," the authors concluded. "Getting injectors into timely HIV care and treatment represents a challenge."

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