title: Predictors of delayed HIV diagnosis in a recently diagnosed cohort.
abstract: Delayed diagnosis of HIV is associated with a worse prognosis despite highly active antiretroviral therapy. Many persons with HIV infection are diagnosed late in the disease process. We conducted a study of 119 persons recently diagnosed with HIV infection to determine the association of health literacy and other factors with delayed diagnosis. Patients were recruited from four publicly funded facilities in Houston, Texas. Health literacy was measured with the Test of Functional Health Literacy in Adults (TOFHLA). Delayed diagnosis was assessed by CD4 cell count at diagnosis. Sixty-five percent of patients had CD4 cell counts 350 cells/mm(3) or less. Twenty-eight percent had inadequate health literacy, but literacy was not associated with CD4 cell count. Thirty-eight percent were tested because they "felt sick." In multivariable analysis, female gender (p = 0.005), reason tested other than "felt sick" (p < 0.001), and marijuana use (p = 0.004) and other illicit drug use (p = 0.01) were predictors of having a higher CD4 cell count at diagnosis. These results confirm that late diagnosis of HIV is common among users of public health care facilities. Expanded routine testing for HIV infection is needed with attention directed to men and persons who may not recognize that they are at risk for contracting HIV infection.
authors.affiliation: Department of Family and Community Medicine, Houston, Texas., Houston Center for Quality of Care and Utilization Studies, Michael E. DeBakey Veterans Affairs Medical Center, Houston, Texas 77030, USA.
authors.forename: Jennifer K
authors.initials: JK
authors.lastname: Mayben
authors.forename: Jennifer R
authors.initials: JR
authors.lastname: Kramer
authors.forename: Michael A
authors.initials: MA
authors.lastname: Kallen
authors.forename: Luisa
authors.initials: L
authors.lastname: Franzini
authors.forename: David R
authors.initials: DR
authors.lastname: Lairson
authors.forename: Thomas P
authors.initials: TP
authors.lastname: Giordano
mesh_terms: D000328:Adult; D018791:CD4 Lymphocyte Count; D015331:Cohort Studies; D003151:Community Health Centers / Q000706:statistics & numerical data*; D005260:Female; D015658:HIV Infections / Q000175:diagnosis* / Q000453:epidemiology; D007722:Health Knowledge, Attitudes, Practice; D006801:Humans; D016014:Linear Models; D008297:Male; D008403:Mass Screening; D008875:Middle Aged; D010342:Patient Acceptance of Health Care / Q000706:statistics & numerical data*; D012307:Risk Factors; D013781:Texas / Q000453:epidemiology; D013997:Time Factors