title: Is access to medical care associated with receipt of HIV testing and counselling?
abstract: Lack of timely HIV testing leads to missed prevention opportunities and poor prevention counselling may be related to further disease spread. We examined the association of self-reported access to medical care with receiving HIV testing and preventive counselling services among a sample of patients with HIV disease prior to hospitalization. We conducted a cross-sectional interview of 217 Los Angeles patients hospitalized with HIV-related illness between 1992 and 1993 and abstracted clinical data from the medical record. Eighty-four per cent of patients received HIV testing prior to hospitalization, but only 33% received preventive counselling services. Only 48% of all patients rated outpatient medical care as somewhat or very easy to obtain. Controlling for severity of illness, better access to outpatient medical care (OR = 1.48; 95% CI = 1.02-2.15), having a regular source of care (OR = 3.40; 95% CI = 1.29-8.97) and non-homosexual mode of HIV transmission (OR = 0.31; 0.12-0.83) were associated with receiving HIV testing services prior to hospitalization. Having a regular source of care (OR = 3.55; 95% CI = 1.37-9.22), being VA (Veterans' Administration) insured (OR = 6.16; 1.46-26.05), older age (OR = 0.95; 95% CI = 0.90-0.99) and having a CD4 count between 101-200 (OR = 0.19; 95% CI = 0.06-0.63) were associated with receiving HIV counselling. Limited self-reported access to medical care is associated with fewer patients receiving HIV testing and counselling. Improving timeliness of HIV testing may require removing the barriers to medical care.
authors.affiliation: Department of Medicine, School of Medicine, University of California, Los Angeles 90095, USA.
authors.forename: D M
authors.initials: DM
authors.lastname: Mosen
authors.forename: N S
authors.initials: NS
authors.lastname: Wenger
authors.forename: M F
authors.initials: MF
authors.lastname: Shapiro
authors.forename: R M
authors.initials: RM
authors.lastname: Andersen
authors.forename: W E
authors.initials: WE
authors.lastname: Cunningham
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000553:Ambulatory Care / Q000706:statistics & numerical data; D003430:Cross-Sectional Studies; D005260:Female; D015658:HIV Infections / Q000175:diagnosis / Q000628:therapy*; D006297:Health Services Accessibility; D006801:Humans; D015141:Los Angeles; D008297:Male; D008875:Middle Aged; D010342:Patient Acceptance of Health Care; D010353:Patient Education as Topic; D011314:Preventive Health Services / Q000706:statistics & numerical data; D019037:Urban Health Services / Q000706:statistics & numerical data