In the current study, the authors designed a cross-sectional analysis of non-pregnant HIV-infected South Carolinians (n=13,042) from Jan. 1, 2004, to Dec. 31, 2006, to identify factors associated with HIV care utilization in the state.

South Carolina mandates reporting of HIV laboratory markers. Adults with reported viral load tests or CD4 cell counts during a calendar year were defined as "in HIV medical care" that year. Care utilization categories were as follows: in care, care all three years; not-in-care (NIC), no care received; and transitional care, during some but not all years. Relationships between care utilization and predictor variables were estimated using multinomial logistic regression using generalized logits.

During the study period, 5,217 (40.0 percent) of HIV-infected adults in South Carolina were NIC and 3,300 (25.3 percent) were in transitional care. While a larger number of black than white HIV-infected residents were NIC, adjusted odds for NIC status were lower among blacks than whites [adjusted odds ratio (AOR), 0.82; 95 percent confidence interval (CI) 0.74, 0.92)]. Women had lower odds of being NIC than men (AOR, 0.66; 95 percent CI 0.58, 0.74). Compared with persons age 55 and older, those ages 25-34 were most likely to demonstrate both NIC (AOR, 1.85; 95 percent CI 1.29, 2.65) and transitional (AOR, 1.85; 95 percent CI 1.31, 2.62) care patterns.

"Large proportions of the South Carolina HIV-infected adult population are not consistently accessing HIV medical care," the authors found. "Targeted programs are needed to improve engagement for HIV-infected adults most likely to transition or not be in care."

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