title: Delayed medical care after diagnosis in a US national probability sample of persons infected with human immunodeficiency virus.
abstract: OBJECTIVE
  To identify health care and patient factors associated with delayed initial medical care for human immunodeficiency virus (HIV) infection.
  
  
  METHODS
  Survey of a national probability sample of persons with HIV in care.
  
  
  METHODS
  Medical practices in the contiguous United States.
  
  
  METHODS
  Cohort A (N = 1540) was diagnosed by February 1993 and was in care within 3 years; cohort B (N = 1960) was diagnosed by February 1995 and was in care within 1 year of diagnosis.
  
  
  METHODS
  More than 3- or 6-month delay.
  
  
  RESULTS
  Delay of more than 3 months occurred for 29% of cohort A (median, 1 year) and 17% of cohort B. Having a usual source of care at diagnosis reduced delay, with adjusted odds ratios (ORs) of 0.61 (95% confidence interval [CI], 0.48-0.77) in cohort A and 0. 70 (95% CI, 0.50-0.99) in cohort B. Medicaid coverage at diagnosis showed lower adjusted ORs of delay compared with private insurance (cohort A: adjusted OR, 0.52; 95% CI, 0.30-0.92; cohort B: adjusted OR, 0.48; 95% CI, 0.27-0.85). Compared with whites, Latinos had 53% and 95% higher adjusted ORs of delay (P<.05) in cohorts A and B, respectively, and African Americans had a higher adjusted OR in cohort A (1.56; 95% CI, 1.19-2.04). The health care factors showed similar effects on delay of greater than 6 months.
  
  
  CONCLUSIONS
  Medicaid insurance and a usual source of care were protective against delay after HIV diagnosis. After full adjustment, delay was still greater for Latinos and, to a lesser extent, African Americans compared with whites.
authors.affiliation: University of Pennsylvania, General Internal Medicine, 1119 Blockley Hall, 423 Guardian Dr, Philadelphia, PA 19104-6021. bturner@mail.med.upenn.edu
authors.forename: B J
authors.initials: BJ
authors.lastname: Turner
authors.forename: W E
authors.initials: WE
authors.lastname: Cunningham
authors.forename: N
authors.initials: N
authors.lastname: Duan
authors.forename: R M
authors.initials: RM
authors.lastname: Andersen
authors.forename: M F
authors.initials: MF
authors.lastname: Shapiro
authors.forename: S A
authors.initials: SA
authors.lastname: Bozzette
authors.forename: T
authors.initials: T
authors.lastname: Nakazono
authors.forename: S
authors.initials: S
authors.lastname: Morton
authors.forename: S
authors.initials: S
authors.lastname: Crystal
authors.forename: P
authors.initials: P
authors.lastname: St Clair
authors.forename: M
authors.initials: M
authors.lastname: Stein
authors.forename: S
authors.initials: S
authors.lastname: Zierler
mesh_terms: D000328:Adult; D019380:Anti-HIV Agents / Q000008:administration & dosage*; D018791:CD4 Lymphocyte Count; D003695:Delivery of Health Care; D003937:Diagnosis, Differential; D005006:Ethnicity; D005260:Female; D015658:HIV Infections / Q000175:diagnosis* / Q000188:drug therapy*; D019538:Health Care Surveys; D006291:Health Policy; D006801:Humans; D008297:Male; D008875:Middle Aged; D016017:Odds Ratio; D010342:Patient Acceptance of Health Care / Q000208:ethnology / Q000706:statistics & numerical data*; D012189:Retrospective Studies; D013997:Time Factors; D014481:United States
chemical_list: D019380:Anti-HIV Agents